By Johannes Marisa
PUBLIC hearings on the Medical Services Amendment Bill are currently ongoing and if signed into law, the Bill gives the Health and Child Care minister powers to force private health institutions to attend to patients without payment in emergency cases for at least 48 hours before transferring them to a government hospital.
Another provision of the same Bill states that the minister may request a private health institution to make its specialist facilities available to patients who need emergency treatment that is not available at government institutions to which they are admitted.
Clause 3 of the Bill will insert a new section 7A into the existing Act that directs health institutions to provide treatment to persons under arrest or detention at the State’s expense.
There has been an overwhelming outcry from the private medical practitioners who feel threatened by the Bill which they say has potential to decapitate private health practice.
It is undeniable that health service delivery at public health institutions is not optimal at the moment as there has been excessive brain drain for the past three years.
The country lost more than 4 000 health workers to so-called greener pastures in the last 36 months, a development which is sad for the health sector.
The private sector stood firm to complement public health delivery service, especially during the peak of the dreaded COVID-19 pandemic when the entire world was quaking.
It is incontrovertibly known that running private health institutions is an insurmountable task that requires capital, which can be debt or equity, and without enough financial resources, many healthcare facilities face closure.
A poorly-resourced healthcare facility can be a liability to patients’ lives as key resources may be difficult to find in the form of oxygen, drugs, sundries, reagents and other medical products.
While some may rejoice that they would now be able to access free emergency medical care at any private healthcare facility, the long-term consequences for the country may eclipse all the anticipated benefits.
It is, thus, prudent to look at the drawbacks of such a move, taking cognisance of the fact that many private healthcare facilities are running on debts that attract unbelievably high interest rates.
The current interest rate from banks is sitting at around 200% and there is no special consideration for the already struggling health sector that has been clamouring for a special loan facility if universal health coverage is to be achieved.
The following issues should be borne in mind if the Bill is to sail through Parliament in its current form which the medical practitioners view as counter-productive.
- The morale at private health institutions naturally collapses as a result of clauses that seem to force the provision of free healthcare services to patients.
Many health conditions can be classified as emergency cases and included in this category are drug abusers who present to healthcare facilities in semi or unconscious states as a result of drug abuse.
Imagine using drugs worth thousands of dollars on a patient who will recover to go back to their drug abuse behaviour.
Some patients are naturally violent and risk being injured in fights and appear in healthcare facilities in unconscious states for them to be treated for free for 48 hours.
Government is not clear who will cater for all the costs that can include sutures, bandages, drugs, drips, salaries and other operational costs.
- There is risk of budget overruns — Keeping patients for free for 48 hours is damn expensive as many items are needed.
Clean linen is required, sundries have to be purchased, food has to be prepared, hence the viability of the private health sector comes under serious threat.
It was going to be feasible with this arrangement if there was a clause in the Bill that highlights that government will pay for the service within a stipulated time.
- There is a risk of poor service delivery at private healthcare facilities — Many patients will surely rush to private medical centres to seek emergency medical services with resultant congestion.
It is possible for one to malinger in a bid to be assisted as an emergency case.
I foresee a situation where private healthcare facilities become more or less similar to public healthcare facilities.
- Cost of health services will skyrocket — There are definitely going to be higher operational costs for private medical centres with a reciprocal increase in cost to patients.
Some will be treated for free, while others will have to sweat to cover the costs.
Failure to adjust on fees will mark the death of many private healthcare facilities.
The Bill, therefore, needs sober scrutiny and proper amendments should be made in order not to frustrate private medical practice.
Together, we drive Zimbabwe!
- Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.