HEALTHCARE reform should begin and end with one question: Will patients be better off?
Everything else is secondary.
The proposed amendments to Statutory Instrument (SI) 330 of 2000, which seek to prohibit medical aid societies from owning or operating healthcare facilities, are being presented as a way of addressing potential conflict of interest within the healthcare system.
At face value, the principle is difficult to dispute.
No healthcare system should tolerate practices that undermine patient welfare, distort competition or place institutional interests ahead of those of the people it serves.
But healthcare policy cannot be made on principle alone. It must be tested against reality.
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And Zimbabwe’s reality is this: public hospitals remain under immense pressure, medical aid coverage is limited, out-of-pocket healthcare costs are high and many Zimbabweans already struggle to access quality care when they need it most.
This is not a healthcare system with excess capacity.
It is a healthcare system with a shortage of capacity.
Against that backdrop, the proposal to dismantle an existing component of healthcare delivery demands careful scrutiny.
The most important question is not whether vertically integrated healthcare models are theoretically imperfect.
Most systems are.
The real question is this: Who stands to benefit from these amendments and what do patients stand to gain?
Certainly not the patient already burdened by shortfalls.
Not the pensioner managing chronic illness on limited means.
Not the family forced to choose between paying school fees and seeking treatment.
The position paper submitted by medical aid societies argues that their involvement in healthcare delivery emerged as a response to practical market failures: unpredictable tariffs, disputes over pricing, capacity constraints and the need to provide members with more affordable and predictable access to care.
One may agree or disagree with that explanation.
But it raises a legitimate question: if these arrangements are dismantled, what replaces them?
Will public hospitals absorb the additional demand?
Can they do so without compromising quality and access?
Will independent providers fill the gap?
If so, at what cost to the patient?
Will the removal of funder-owned facilities strengthen the bargaining position of other players within the healthcare value chain, resulting in higher tariffs and greater out-of-pocket expenses?
These are not accusations.
They are policy questions.
And they deserve answers.
If vertically integrated facilities have caused demonstrable consumer harm, restricted patient choice or distorted competition, then the evidence should be placed before the public. Regulatory intervention would then be justified.
But if such evidence has not been clearly established, policymakers should be cautious about implementing one of the most far-reaching structural changes in Zimbabwe’s healthcare landscape.
Good regulation addresses specific risks.
It does not dismantle functioning capacity unless there is compelling evidence that patients will be better served as a result.
This is not an argument against reform.
Medical aid societies should be subject to rigorous oversight.
Related-party transactions should be transparent.
Governance standards should be strengthened.
Competition laws should be enforced.
Pricing practices should be monitored.
Abuse, where it exists, should be confronted decisively.
But there is a difference between reform and demolition.
Zimbabwe cannot afford to weaken healthcare capacity on the assumption that something better will automatically emerge.
The burden of proof rests with those advocating the amendments.
They must demonstrate that patients will enjoy lower costs, better access and improved outcomes once the reforms take effect.
Will healthcare become more affordable?
Will quality improve?
Will access expand?
Will patients be better protected from catastrophic healthcare costs?
If those questions cannot be answered with confidence, then caution is not resistance to reform.
It is responsible policymaking.
Healthcare policy should not be driven by ideology, institutional rivalry or sectoral interests.
It should be guided by evidence and by the welfare of the ordinary Zimbabwean seeking care.
Zimbabwe should reform healthcare with a scalpel, not a sledgehammer.
Because if this experiment goes wrong, it will not be policymakers, funders or providers who suffer first.
It will be the patient standing in a queue, searching for care that has become more expensive, more distant and harder to access.
lGilbert Nyatanga is a social and economic commentator who is passionate about health issues