Zimbabwe’s healthcare system is not suffering from an excess of capacity. It is suffering from too little of it.
That is why the proposal to force medical aid societies to divest from hospitals, clinics and specialist units under amendments to Statutory Instrument 330 of 2000 deserves far greater scrutiny than it has so far received.
The stated objective of the proposed reforms is noble enough: eliminate conflicts of interest by separating healthcare funders from healthcare providers. On paper, the argument appears straightforward. An insurer should not own the facilities to which it directs patients.
The problem is that healthcare does not exist on paper.
It exists in overcrowded waiting rooms, medicine shortages, escalating tariffs and a country where the overwhelming majority of citizens have no medical aid cover at all.
The position paper submitted by major medical aid societies asks a simple but uncomfortable question: What problem exactly is this reform trying to solve?
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No evidence has been publicly presented showing that vertically integrated medical aid facilities have harmed patients, monopolised healthcare delivery or foreclosed competition. On the contrary, the submission argues that funders ventured into service provision because the market itself had failed to provide predictable, affordable access to care.
Private providers have historically resisted common tariffs. Patients have routinely faced shortfalls. During periods of economic instability, service disruptions have become commonplace. Medical aid societies responded by investing in healthcare infrastructure to guarantee access for their members.
The result was not the elimination of private practice. In fact, the data tells a different story.
According to the submission, only a minority of members use society-owned facilities, with most healthcare services still being obtained from external providers. The narrative of monopolisation therefore collapses under its own weight.
What the proposed amendment seeks instead is structural separation through forced divestiture.
That should alarm policymakers.
Compulsory disposal of lawfully acquired assets within a fixed timeframe creates the conditions for distressed sales, destruction of shareholder value and weakened balance sheets. Health funders warn that the ultimate consequences may include higher contributions, reduced benefits and increased out-of-pocket costs for patients.
Ironically, those supposedly being protected could end up paying more.
The proposal also raises a deeper constitutional question.
Section 76 of Zimbabwe’s Constitution guarantees the right to access basic healthcare services. Any limitation of rights must be reasonable, necessary and proportionate. Yet a blanket prohibition affecting voluntary associations that pooled member resources to improve healthcare access appears to be a blunt instrument where more targeted solutions exist.
Conflicts of interest in healthcare are real. They should be managed.
But regulation should distinguish between abuse and utility.
Ring-fenced governance structures, transparent transfer pricing, independent audits, open-network access, tariff oversight and Competition and Tariff Commission supervision all offer mechanisms to address legitimate concerns without dismantling service capacity.
This is how many jurisdictions approach insurer-provider integration: regulate the risks while preserving the benefits.
Zimbabwe cannot afford ideological healthcare reform detached from market realities.
A country where medical aid coverage remains limited and out-of-pocket spending remains high should be asking how to expand affordable access, not how to shrink existing capacity.
Good policy should solve problems, not create new ones.
Before government breaks apart institutions that have become an integral part of healthcare delivery, it must answer the most important question of all:
Will ordinary Zimbabweans find it easier or harder to access affordable healthcare once this reform is complete?
If that answer cannot be clearly demonstrated, then caution is not obstruction.
It is public policy wisdom.