Dr Cletos Masiya
Zimbabwe has seen a rapid increase in the number of medical aid societies and medical funds in the past eight years. From a few previous household names we knew back then, now we have over 30 medical aid organisations in the country.
The key questions to ask are many.
Have we seen an increase in the number of citizens who are now covered on medical aid?
Has the quality of cover improved through improved products offering?
Has the cost of cover been reduced due to a more competitive environment?
During the same period under review, the number of private healthcare facilities — which include surgeries, clinics and even 24-hour emergency rooms and hospitals — has also increased especially in major cities such as Harare, Bulawayo, Gweru and Mutare. This has also seen even smaller towns having an increase in private healthcare facilities.
Has access to patient care improved given the changes noticed in the two critical pillars of healthcare, namely health funding and health service provision?
Before we quickly answer the above questions, let’s look at basic definitions and classes of healthcare financing.
Medical aid is a shared resource and shared facility where the healthy support the sick in times of medical distress. It is a collective facility where different members pool together their financial resources to meet the costs of a sick member in times of need. The assumption is that members won’t all fall sick at the same time such that there is a pot to draw from financially to pay these arising medical bills.
Medical aid is, thus, different from health insurance, which is a special medical product to cover a specified future medical catastrophe or illness. In Zimbabwe, medical aid organisations are governed by the Health ministry under the Medical Aid Act, while medical insurance is regulated via the Insurance and Pension Commission. Hence, the former, while it is a financial service, falls under the Health ministry rather than the Finance ministry.
This structure has key implications in unpacking some of the challenges that have been bedevilling the medical aid and health services industry.
Now let’s go back to our above questions. There has not been much increase in the number of Zimbabweans under medical aid. We still have around only 10% of the population being medically covered.
At the same time, despite the increase in the number of medical service providers in the private sector, we still have gross challenges of patients accessing services as it is largely expensive for patients to foot their medical costs out of pocket.
One of the key problems that has gone on for many years is the dispute in re-imbursement levels between service providers and medical aid socities. I was looking at a ministerial statement issued by the then Health minister David Parirenyatwa in Parliament on June 23, 2016. He was giving a feedback report on what he termed: Challenges in working relationships between medical aid societies, ahfoz (Association of Healthcare Funders of Zimbabwe) and providers of healthcare.
Parirenyatwa highlighted the following items four years ago which are still at the centre of major challenges we are still experiencing today:
lThere have been disagreements over tariffs for various areas of service provision.
lPayment by insurance to providers based on the insurers preferred tariff rate.
lDelays in meeting payment for services rendered.
lReferral of clients by insurers to preferred networks of providers in their clinical and laboratory facilities.
lConflict of interests by insurers by way of building, owning and running medical and dental clinics, hospitals, pharmacies, laboratories, radiological centres, rehabilitation units, optician clinics and other related health centres.
lThere has been disregard of gazetted fees by the insurers and payments coming more than 60 days especially in this hyperinflationary environment.
At that time the medical aid socities also raised the following issues:
lThere has been disagreement over tariffs for various areas of services provision.
lCharges by providers that are way beyond what the insurers can afford.
lDemands by providers from patients for cash payment upfront while the clients are holding valid insurance cards.
For us who are part of the Medical and Dental Private Practitioners of Zimbabwe Association (MDPPZA), a broadly representative organisation of various health practitioners across the board, we feel that the above issues are the reason why the number of insured has not grown as people don’t see the value of being under a medical aid society.
Another reason is affordability. The harsh economic environment obtaining in the country leaves very few people with extra income to afford insurance. A private package from one of the biggest medical aid socities costs $13 500 for a family of three. Despite this, the members will still find themselves accruing shortfalls.
Thus, there is strong need for organisations such as one I belong to MDPPZA, which represents over 300 health practitioners across the country, to lobby for a win-win scenario with medical aid societies all for the benefit of the patients.
However, this needs the active involvement of the regulator, who is the Health minister.
Both the service providers and funders need now to innovate and find ways of cutting down costs to come up with new products that are accessible and affordable to our population.
lDr Cletos Masiya is a private medical practitioner with 16 years’ experience in medical practice having worked in the public sector, non-governmental organisations and holds a medical degree from the University of Zimbabwe and a Masters degree in Clinical Endocrinology from the University of South Wales. He is the secretary-general of MDPPZA.