Discovery taking responsibility is welcome, but ethics demand more

As a medical aid scheme member, I welcome Discovery Health’s recent decision to terminate the process of recovering fees erroneously paid to pharmacies from January to December 2025. This signals recognition that members should not bear the financial consequences of a lapse outside their control.

Read more: Regulator probe, public uproar spare 16,507 Discovery Health members from R125m billing error

This incident offers a critical opportunity to interrogate the line between legal compliance, remedial action and ethical responsibility in the medical aid industry, particularly in an era when complex systems increasingly embrace automation, which may amplify administrative errors.

Remedy addresses harm, not cause

Taking financial responsibility for the affected members mitigates the immediate financial harm caused by members starting their new-year health journey with very limited medical aid benefits, or a negative balance. The remedial action, although plausible, does not, on its own, address the deeper ethical questions raised by this incident.

Members were not merely exposed to unexpected costs; they were deprived of timely, accurate information that would have enabled them to exercise their choice and make alternative clinical or financial arrangements for the prescribed medicines. The ethical harm here lies as much in the loss of opportunity and autonomy as in the monetary impact. Members missed an opportunity to exercise their autonomy, for example, by having treatment plans adjusted or even by deferring care, had they known that additional benefits for access to treatment were subject to co-payments.

The Council of Medical Schemes will further look into the processes and oversight gaps that led to the incident. Without systemic learning, the risk of recurrence remains.

Law sets the minimum; ethics set the expectation

Medical aid schemes operate within a regulatory framework, but healthcare financing is never morally neutral. Decisions about benefit administration shape access to care, personal financial trade-offs, and trust. When errors occur, members may face unexpected costs and delayed access to care, compromising their health, productivity at work, and social wellbeing.

Governance demands more than technical fixes. It requires asking not only “Have we corrected the error?” but also: “What does this failure reveal about how we exercise power over members’ lives?” These questions shift accountability from a narrow compliance lens to a broader reflection on justice, autonomy and institutional responsibility.

Ethics raises standards beyond the minimum required by law.

System error, procedural compliance and human impact

It remains ethically insufficient to attribute failure solely to a “system error” because systems do not design themselves. They do not independently set benefit rules, decide which anomalies warrant escalation, or determine how long an issue may persist before intervention. Every system reflects human choices, governance priorities and oversight practices.

The fundamental questions, therefore, remain: What monitoring mechanisms were in place to detect abnormal utilisation? Why did those mechanisms fail to trigger earlier action?

Financial remediation must be paired with an explicit acknowledgement of human and institutional responsibility. Systems and automation may streamline processes, but it does not erase moral agency. Ethical leadership means owning the decisions behind the systems, not hiding behind them.

This case illustrates a recurring tension in large organisations, where procedural compliance risks “crowding out” human-centred reasoning. Organisations should be attentive to human impact, not just actuarial models and legal thresholds.

Administrative justice and equity across options

The recent decision rightly prevents members from bearing an unfair burden. However, broader justice considerations remain relevant. Where errors arise within specific benefit options, particularly premium options, it is ethically important to ensure that remediation does not result in unintended cross-subsidisation of members on lower-cost plans with fewer benefits and less financial flexibility.

Administrative justice requires that responsibility align with the source of error, that remedial costs are accounted for transparently, and that equity across the risk pool is explicitly considered.

Justice in medical schemes and their administration is not only about solvency; it is also about the fair distribution of risks and benefits.

What ethical accountability looks like after remediation

If approached through the lens of procedural justice and human-centred ethics, accountability would include:

1. Clear explanation of how the error occurred.
2. Explicit acknowledgement of governance and oversight gaps.
3. A meaningful apology that recognises harm, not merely inconvenience.
4. Transparent articulation of corrective and preventive measures. Remedy without reflection risks recurrence.

Beyond this case

This incident should be viewed as a broader lesson for the industry.

As healthcare administration becomes increasingly digitised, complex and automated, ethical oversight must keep pace. Addressing problems is necessary, but insufficient. Institutions must also learn ethically from failure.

In healthcare, administration is never morally neutral. Even when harm is unintended and remedied, responsibility remains human. Ethics demands that institutions ask not only “Did we pay?” but also: “Did we prioritise human impact over procedural thresholds?”

Compliance is the floor; human-centred governance is the ceiling. DM

Brenda Kubheka-Chauke serves on one of the committees of the Health Professions Council of South Africa. She is a member of the Council of the Gauteng North branch of the South African Medical Association, an African Leadership Initiative (SA) Fellow and an Aspen Global Leadership Network member.