Zimpapers Logo

Some feel that Government is punishing and generalising what happened at Premier Service Medical Aid Society with all other funders

Paidamoyo Chipunza Living Life
The issue of medical tariffs took prominence at this year’s all stakeholders conference for medical aid societies which took place in Victoria Falls this week.The saying that when two elephants fight, it’s the grass that suffer best describes the current scenarios characterising the medical costs debacle.

The issue of access to healthcare for people on medical cover becomes a cause for concern as the battle between the two medical giants rages on.

Although Government, as the regulator of medical aid societies in Zimbabwe intervened and imposed a common tariff expected to be used by both service providers and health insurers, the general feeling is that the new medical tariffs were unjustified and too high for a deflationary economy.

Thus medical aid societies are failing to pay service providers the gazetted tariffs of US$35 for general practitioners and continue reimbursing them at the previous rate of US$20.

Equipped with the new gazetted tariffs, service providers on the other hand insist on being paid the US$35. That means someone has to pay the difference and in this case sadly it’s the patient through shortfalls, co-payments and sometimes cash up front.

During the conference, Deputy Minister of Health and Child Care Dr Paul Chimedza told funders to re-engage with providers for a lasting solution but ordered them to comply with the existing legislation as they re-engage.

“The idea is not to drive any of the parties out of business or out of the country but we strive to strike a balance in line with our current macro-economic situation. We actually prefer no casualties and therefore still expect the involved parties to engage,” he said.

The big question now is, what has changed? Both parties have been failing to agree since 2008 and what will make them agree this time around?

It looks like the health of ordinary Zimbabweans, those few who are on medical aid is at stake.

Deliberations from AHFoZ conference were pointing towards re-packaging members’ benefits depending on one’s affordability.

Some of the recommendations made include coming up with packages that cater for hospitalisation only and do not cover other medical services such as dental. A case study cited of where these packages are is Switzerland.

Other recommendations include coming up with packages that emphasises on lifestyle choices to prevent sickness, minimising preventable hospital admissions and reducing emergency room visits.

Medical aid societies are also looking into possibilities of group practices rather than the current ‘sole trader paradigm’ to minimise costs that are lost through administrative demands.

While all these ideas sound excellent to the funders as well as the providers, those that are left vulnerable are the clients.

Capture this: Your child suddenly develops a fever while you are away from home. Your medical package only covers hospitalisation but the condition your child is suffering from requires some antibiotics which are only sold on prescription. The only person to make that prescription is a general practitioner who wants his US$30 cash up front.

Imagine the stress that you go through trying to look for that money to enable your child seek services of a GP when previously you would just use your medical aid to have the child treated.

Your failure to pay cash for the child’s treatment could worsen your child’s condition. It is therefore evident from this scenario that those that will suffer from this fighting are the patients.

Funders will never shape out, in-fact they will come up with innovative packages that suits their operations while service providers will always benefit from whatever packages that will be available. But what happens to the generality of the population?

In an interview on the sidelines of the AHFoZ conference Dr Chimedza said service providers have since approached his ministry over non-compliance by the societies to stick to the gazetted tariffs.

He said the societies would be summoned for questioning concerning their non compliance.

But delegates at the conference, the majority of whom were from medical aid societies had no kind words for the minister.

Institute of People Management of Zimbabwe Vice President Mr Simisani Makeba said consumers feel betrayed by Government by allowing doctors to increase tariffs in a deflationary economic environment.

“The intervention taken by the regulator (Government) was very controversial. It affects the consumer more than the doctors and the medical aid societies,” said Mr Makeba.

Others felt that Government was punishing and generalising what happened at Premier Service Medical Aid Society with all other funders.

PSMAS became popular for awarding its executives heaven on earth contracts yet they failed to pay service providers their dues.

Other participants grilled the minister over the justification of such increases arguing that health costs in Zimbabwe were already beyond the reach of many even before the new tariffs were effected.

Dr Chimedza defended Government’s position saying everything was over priced in Zimbabwe and the medical sector was not an exception.

If Government fails to end this impasse, it would have failed its people as they look up to it for protection of its interests.

Government gazetted new medical tariffs in May, which saw an increase of general practitioners consultation fees from US$20 a visit to US$35 and from US$80 for specialist services to US$120.

About 1,5 million people in Zimbabwe are on medical aid while 31 medical aid societies have been registered.