Abstract

Author:
Michael Mncedisi Willie

Doi: 10.26480/jhcdc.02.2024.57.60

This is an open access article distributed under the Creative Commons Attribution License CC BY 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Medical schemes offer private healthcare coverage through structured mechanisms that enable members to pay regular premiums for various services. These schemes operate alongside the public health sector, are funded through taxes and aim to provide essential services to all citizens. While medical schemes, serving less than 15% of the population, account for over half of the country’s health expenditures, they face significant challenges, including governance issues, conflicts of interest, and regulatory compliance. This article explores the various approaches to managing conflicts of interest within medical schemes, highlighting the importance of transparency, independent oversight, and adherence to regulatory standards. The study underscores that disputes can arise from governance, benefit design, provider contracts, and other areas, and it provides strategies for effectively addressing these conflicts. Key strategies include promoting transparency and disclosure, establishing robust codes of conduct, implementing apparent conflict of interest policies, providing ongoing training, consulting independent experts, and ensuring rigorous monitoring and auditing. This comprehensive approach aims to preserve the integrity of medical schemes and enhance trust and accountability among stakeholders.