BY JOHANNES MARISA
THERE has been talk about health service delivery in the country since time immemorial. Daggers have been drawn with service providers accusing the health insurers of playing politics while the medical aid societies blame service providers for the high cost of medical care. This has resulted in some patients seeking healthcare services outside Zimbabwe. The blame game has not done justice to patients who are consequently caught in the middle of the scrimmage. The acrimony seems to be far from over.
Medical aid societies (MAS) are governed by the Health and Child Care ministry. The ministry is there to provide oversight on the construct and conduct of medical aid societies in Zimbabwe.
Statutory Instrument 330 of 2000 deals with medical aid societies. It is from this instrument that medical aid societies are regulated from registration, their operational conduct, financial matters to dissolution.
It is also from the same instrument that members of the public are guided on the general rules and regulations which form the basis for some of the rules that are imposed by the medical aid societies.
In the 18th century, Vilfredo Pareto, an Italian civil engineer, came up with what is now termed Pareto optimality or efficiency.
This is a scenario where no individual can be better off without making at least another individual or preference criterion worse-off.
Someone has to bleed in order for the other to remain viable in many businesses. Many service providers have closed shop and left our beautiful country because the economic environment is deemed too hostile.
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Many medical aid societies have forgotten that their ethical duty is to honour claims sent to them.
Refusing to pay service providers, yet patients are banking on them as responsible insurers is not only cruel but an act of indelicacy that should be condemned by everyone. Yes, I admit that there are some good performers such as First Mutual, Alliance, CIMAS, Liberty, Generation Health, Ultramed Medical Aid Societies Access that have tried to honour claims although with some unpalatable conditions.
People should appreciate that it is quite expensive to run medical centres, clinics, hospitals, laboratories, pharmacies et cetera. All these entities employ staff that requires salaries, PPE, food and transport.
Administratively, bills have to be paid to councils and regulatory bodies, leaving many practitioners incapacitated to run private practices.
While many may postulate that medical practitioners are living large in Zimbabwe, it is an incontrovertible truth that many of them are still walking on foot, years after graduating from medical school.
Service providers need to be paid their dues and it is disappointing that some medical aid societies are going for more than six months without even paying a single dollar, a move that is indelicate and discourteous.
Questions linger in our minds as to why medical aid executives drive state-of-the-art cars yet their clients are denied treatment because the insurers are not honouring service provider claims. For long, some medical aid societies have taken advantage of the disunity that was prevailing among service providers.
Many practitioners have often complained about the conduct of some of the insurers who have often used the divide-and-rule tactic.
We have always complained but our complaints have fallen on deaf ears with some of the medical aid societies constantly exhibiting imperious and magisterial behaviour that further infuriates the service providers.
Non-payment
Many service providers have been frustrated by some medical aid societies which take time to honour claims.
Some of the MAS cite flimsy reasons to evade payment.
How can a whole claim be rejected because a patient’s date of birth is not clear on the form yet it can be corrected in the system?
A service provider will have attended to the patient, gave all the necessary drugs, used all the available PPE and the claim form is not honoured three months down the line. Such practice should never be tolerated!
Officious communication
On numerous occasions, some medical aid societies act as bullies by imposing what suits them.
Service providers have a lot of things imposed on them, a practice that is so frustrating to many.
During the peak of COVID-19, one medical aid society just wrote to practitioners telling them that they would not immediately honour manual claims as they had to wait for 21 days of quarantine.
How offending and injudicious it was yet the same money was needed like yesterday.
Too many rules
It is a pity that some medical aid societies do not honour some claims because they will be coming from general practitioners.
A patient who suffered a stroke requires a CT scan which a doctor should order.
Surprisingly, the general practitioners are prohibited from signing for CT scans even for simple cases.
The order comes from non-medical people who do not appreciate the importance of a practitioner.
I wonder why some big organisations put their employees at risk by engaging the services of certain medical aid societies.
Is it because they do not do due diligence or it is because of nepotism or corruption?
Honestly, you cannot understand why a whole organisation would switch from a good medical aid society to a bad one, exposing the entire staff to poor service.
We have a long list of poor performers in the industry who should wake up from their slumber and respect the service providers before it is too late.
Time for mere profiteering is over!
- Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.
