Statement on medical aid sparks debate

Herald Reporter
A recent announcement by Finance and Economic Development Minister Professor Mthuli Ncube on the likelihood of the Insurance and Pensions Commission (IPEC) regulating medical aid societies has sparked furious debate in light of the state of affairs in the health sector.

Health institutions, particularly in Harare and Bulawayo, are operating at suboptimal levels, with patients finding relief in health insurer administered facilities and church-related hospitals.
Most patients avoid exorbitant costs in the private sector.

While health insurers have argued that owning health facilities was “simply complimentary” to existing institutions of care, service providers argue that they are actually in conflict of interest and should be stopped from providing the services that they also fund.

Government, through the Medical Aid Services Bill, is looking forward to regulating health insurers, and addressing the issue of conflict of interest. Arguing against provision of services by the health insurers, the Zimbabwe Medical Association (ZIMA) yesterday dismissed claims that insurers were complementing existing health facilities.

ZIMA said the health insurers were actually “duping” their members through hefty premiums, the bulk of which were consumed by salaries and perks.

“It is alleged that medical aid societies create vehicles for health services provision under the guise of providing cheaper health services,” said ZIMA.

“In reality, patients are being duped to pay hefty premiums for insurance where the bulk of the money is used to pay the health insurers’ management perks and salaries.”

According to ZIMA, while patients are happy not to pay deposits or shortfalls, which they are normally charged in private facilities, services they get from facilities owned by medical aid societies are of questionable quality.

ZIMA said patients were rarely seen by the same doctor twice and there was no continuity of care.
“This explains their reluctance to disclose what proportion of the medical aid contribution is actually used to pay the cost of services rendered compared to what is used in perks and salaries,” said ZIMA.

Although the Medical Aid Services Bill is yet to be tabled before Parliament for debate, presenting the 2020 national budget recently, Professor Ncube hinted that medical aid societies would soon be regulated by IPEC.

“Government is reviewing the current regulatory framework with a view of consolidating all insurance, medical aid schemes, legal aid societies and pension funds, including the National Social Security Authority, under a single regulator – IPEC,” said Prof Ncube.

IPEC Commissioner Dr Grace Muradzikwa yesterday said they were still waiting for direction from Government on the way forward regarding regulation of medical aid societies, as well as legal aid societies.

IPEC is on record as saying it already has provisions that deal with mutual societies such as medical aid, citing the Insurance Act (Chapter 24:07), particularly sections 11 to 21.

This means the legal framework enabling the regulation of medical aid societies is in place, though there will be need for some amendments to both the existing Medical Services Act and the Insurance Act.
ZIMA is also on record advocating for regulation of medical aid societies by IPEC.

Some medical aid societies are regulated by IPEC, while others fall under the Ministry of Health and Child Care.
The Ministry of Health and Child Care has also been working on the Medical Aid Societies Bill, which is yet to be tabled in Parliament for debate.

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