Sanyanga sheds light on medical aid

Of late, issues of health insurance, otherwise known as medical aid are becoming topical. Topical because of a myriad of challenges bedeviling the sector leading to many questioning their relevance. In the following interview, Association of Healthcare Funders of Zimbabwe chief Executive officer, Ms Shylet Sanyanga, shades more light on the concept of medical aid and the operating environment. 

 

  1. Ms Sanyanga, who is AHFoZ and what is your role in the medical aid industry?
  2. The Association of Healthcare Funders of Zimbabwe is an umbrella body for medical aid societies. It was formed in 1969 and currently has a membership of 36 funders, including two regional members.

Our role as an association is to be the industry voice, addressing industry issues such as negotiation and standardization of tariffs, accreditation  of Healthcare service providers intending to do business with medical aid societies, fighting fraud, waste and abuse, lobbying and advocating for policy positions on behalf of our members as well as to raise medical aid awareness to the generality of the Zimbabwean population.

 

 

  1. One might wonder, what is medical aid?
  2. Medical aid is a form of insurance where members pay a monthly fee (called a contribution or premium) in return of financial cover for medical treatment or related medical expenses when the need arises.

Medical aid members contribute money into a pool on a regular basis to cover health-related expenses for any one of the contributing members as and when the need arises.

 

  1. How does that work?
  2. The medical aid concept operates on the principle of pooling resources and cross subsidy. The well subsidize the sick, and the young subsidize the old.  Due to the nature of healthcare interventions often required, a contributing member may easily exhaust their own contributions and they go onto benefit from contributions made by others contributing into the pool.

 

 

  1. Why should people be on medical aid ?
  2. It is important to have a financial fallback plan when emergency health situations arise, rather than to be caught unaware and not financially prepared. Illness always strikes when people are least prepared financially.  In such situations, the medical card comes to the rescue by enabling access to healthcare services.

It is advisable to join medical aid as soon as one has a regular income. Trying to join medical aid at an advanced age is difficult and expensive. This is because health usually starts to fail as people age.

 

It is important for people to value investing in healthy and productive lives and avoid premature death, which may be avoidable if one gets access to healthcare services

 

In essence, medical aid coverage;

 

  • Lessens the financial burden on healthcare service costs when one’s health or a loved one’s is threatened.

It is quite evident that healthcare costs are extremely high in these days and just one treatment can deplete any emergency funds that people may have. This is where medical aid coverage comes in.

  • Helps members to get early treatment and regular health checks, rather than waiting for one to get sick. One does not need to visit healthcare practitioners only when sick, but also for health checks.
  • Gives members the preference of going to an institution of choice. Medical aid schemes offer various packages to their members from the lowest to the highest plan, which enables people with different budgets to choose accordingly.

 

 

 

  1. What should one consider when choosing the right medical aid scheme?
  2. There are different medical aid schemes to choose from in Zimbabwe. People can choose cover that suits their needs and their budget i.e.

 

ü Affordability

 

ü Quality

 

ü Reliability

 

  1. What are some of the key challenges faced by medical aid societies in Zimbabwe.

 

  1. Medical aid companies are not spared from the broader macro-economic environment affecting business in the country. These range from pricing disparities emanating from different exchange rates applied by players in the healthcare supply chain, in an effort to preserve value.

 

 

Whilst some suppliers of Healthcare services are chasing the  parallel  exchange rate,  medical aid societies can not do the same as this would mean frequent reviews of contributions. This would not be affordable and sustainable for the contributing members whose salaries are not being reviewed at the same frequency. Therefore, this disparity  has resulted in patients having to pay  shortfalls and co-payments in some instances.  The levels of shortfalls differ from provider to provider.

 

Whilst on one hand AHFoZ has a guideline of scientifically determined tariffs that its members can use to reimburse service providers, on the other hand, service providers  have their own tariff. Whilst many service providers use the AHFoZ Tariff, some providers choose to use their own Tariff which usually leaves  shortfalls and co-payments for members to settle at the point of Care.

 

For example, the AHFoZ rate of reimbursement for consultation fees to a Physician is USD$85.50 but some providers  may charge  up to  USD$100.00. This means the difference is what the member will be asked to pay as a shortfall.

 

Regrettably,  some key private healthcare service providers are no longer accepting patients  on local currency  packages. This impacts on the number of available options for accessing services for those members  under local currency packages.  Such a situation is beyond the members or the medical aid, since salaries in the formal sector are still predominantly paid in the local currency. Medical aid contributions are usually deducted from salaries and members can only pay from the currency that they are earning their salaries in.

 

As AHFoZ , we urge our members to use contribution rates  actuarially determined by  experts so that the contributions can meet the claims costs. Charging sub-economic rates renders the medical aid system ineffective. A combination of sub-economic rates and exchange rate disparities makes the situation worse.

 

So for those who would want to join medical aid, how do they know the different providers available in Zimbabwe

 

Members of the public who would want to join medical aid are encouraged to visit the AHFoZ website under the members’ section, www.ahfoz.org. There is a list of all medical aid societies registered under AHFoZ and people may go through all of them in search of a scheme that best suits their needs. For any further enquiries, people may also contact AHFoZ on [email protected] .

 

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