Patients the losers in the medical aid societies, service providers fight

Medical Aid Societies

By Johannes Marisa
For any organisation to remain afloat in a hostile economic environment, there should be a robust strategy. Both external and internal environmental analysis should be carried out in order to satisfy the four levels of strategy, that is, corporate strategy, business, functional and operational levels.

Many businesses have gone into liquidation or extinction because of poor strategy frameworks, poor implementation of the strategies or failure to do a proper environmental analysis.

Zimbabwe has a population of about 17 million people of which about 10% of them are members of medical aid societies (MASes).

More than 12 million people are not covered by medical aid societies. This means that in case of health challenges, one has to depend on out-of-pocket payments in order to meet the required costs.

The Alma Ata Declaration of 1978 identified primary health as key to the attainment of universal health. The gross inequality in the health sector is politically, socially and economically unacceptable and should, therefore, be a cause for serious concern for any government.

Zimbabwe is serviced by more than 30 MASes which are competing for less than 1,8 million members. This means that there is either sluggish membership recruitment drive with resultant stagnancy or that many people are dropping from such health schemes.

There are various contributory factors which include an unsustainable economy, high unemployment rate, ignorance and general lack of confidence in medical aid societies.

There has been a serious tiff between health service providers and medical aid societies for a long time now. Health service providers have been grumbling about delayed payment or non-payment at all by the MASes while there are widespread reports of rampant abuse of funds from some of the biggest MASes.

Large perks are paid to executives who drive state-of-the-art vehicles at the expense of service providers who sweat for long hours serving patients.

The painful thing is that those who work hard to deliver healthcare are the last ones to be considered for payment. The arrogance shown by some of the MASes, coupled with various delusional declarations from the health funders is nauseating.

Dictation is never tolerated but respectful engagement that yields results is the panacea to all problems. Recently, I received a call from Premier Service Medical Aid Society (PSMAS) advising me that some of our claim forms were not going to be honoured because of late submission.

I wondered why such things are allowed to happen when the same medical aid society can stretch for many months without paying, with no repercussions.

This shows they are only concerned about themselves, a situation which should never be tolerated.

How can one continue to accept patients who are members of medical aid societies that take advantage of technical glitches yet service was rendered during the dangerous time of COVID-19 when all of us stood tall to defend our beloved country?

Many health practitioners are in the same predicament today with no solution in sight. Private practitioners are economically hamstrung and that has resulted in massive brain drain to countries like the United States of America, United Kingdom, Australia, Namibia, South Africa to mention but a few.

The consequences of the tiff between MASes and service providers disadvantages patients. The practitioners are left with no option except to demand cash upfront or to decline medical aid cards. Patients face a double tragedy with monthly premiums going to MASes while cash is squeezed from their pockets when they need medical attention.

That factor has contributed immensly to a decrease in the number of  people who are on medical aid cover. It is absurd for people to join schemes that will not come to their rescue when they need help.

It is imperative that medical aid societies establish good relations with service providers and shun the traditional confrontational culture for the betterment of their clients who happen to be the patients.

While it is good to develop health infrastructure in our country, the stance taken by MASes to plant many clinics in many towns and cities remains unfair if service providers are not paid their dues.

COVID-19 came with numerous patient admissions especially during the second and third waves of the pandemic.

Many MASes went into hibernation and could not admit their clients at their facilities. Some of the practitioners who stood firm against the dreaded and heinous virus have not been paid their dues because of technical issues. Imagine the cost of drugs, oxygen and the overall risk involved in COVID-19 management.

Respect service providers as they are key in health service delivery!