THE medical industry is one of the most delicate industries in the world because it deals with life and death issues. It needs diligence and love to be there after having spent close to seven years for doctors at university trying to understand anatomy, physiology, embryology, histology, pathology, pharmacology and many more. The journey is crooked for many especially those who cannot proceed smoothly to the next level.
Zimbabwe has both the public and private sectors serving the 16 million citizens of the nation with about 3 000 doctors doing their best to keep the health delivery system afloat. Public health institutions are struggling at the moment with a barrage of problems that include gross understaffing, brain drain, demotivated workforce, obsolete equipment, maladministration and corruption to mention just but a few. The private sector has stood tall to make sure the country does not sink. COVID-19 came and ravaged the world, many people succumbed to the virus but our country, united with a common goal of reducing both morbidity and mortality. Today, we are all smiling although we have to remain alert about post-COVID-19 syndrome, a condition which can haunt us even years after contracting the virus.
In 1979, Michael Porter of Harvard Business School came up with the Five-forces Model which looks at the competitiveness of a particular industry. The threat of entry, inter-company rivalry, substitutes, bargaining powers of both buyers and suppliers should all be considered. Medical practitioners have been grumbling about the way medical aid societies deal with them. The war has been there since time immemorial but the burning issues are that of delayed payments, non-payment, bullying and unilateralism on the part of the health funders. The biggest medical aid society, Premier Service Medical Aid Society (PSMAS) has perennially brought misery to service providers by not honouring its dues. The behaviour of most of the medical aid societies is forcing medical practitioners to close shop and migrate to greener pastures in countries like Australia, United Kingdom, New Zealand, Germany, etc. People should know that private practitioners are no exception when it comes to business. They also struggle to pay rentals, salaries and regulatory authorities and to buy drugs and sundries. The task becomes insurmountable when one cannot reap what they sowed. At one time, I was left dumbfounded when one patient’s claim was rejected merely because I had used the wrong tariff. Instead of correcting the tariff, the medical aid society threw the papers away despite all that had been done to save the patient. Imagine the oxygen, the drugs required, the staff that worked. Clients carrying the same medical aid card will surely not be assisted if they do not have cash.
The micro-economic environment in the country is a thorn in the flesh of service providers who are still accepting medical aid card holders when payment is done three months later. With runaway inflation of close to 700%, the operating environment is venomous and unsustainable, thus making medical aid unattractive. What is needed today is for service providers to demand cash from clients, which can be reimbursed by the respective medical aid society. Imagine being paid $40 000 after two months at the current inflation rate. By then it would translate to just US$2.
Patients should understand that paying medical aid contributions in US dollars is not an automatic qualification to be attended to at medical institutions. The money is not paid to the service providers but to middlemen who may decide to divert it to purchase high-tech vehicles, houses or whatever they deem necessary. Government took long to understand the clandestine operations at PSMAS when service providers were complaining about issues of non-compliance with the laws governing medical practice. It is after unprecedented embezzlement of funds that arrests are now made, years after boohooing by the practitioners. Had the regulator listened then, the current quandary PSMAS card holders find themselves in could have been averted. It is my advice that organisations that want to join a particular medical aid society practise due diligence. Service providers have insight into many of the existing medical aid societies and their assessment is good for clients. Patients should not continue to suffer when medical aid society executives spend millions of dollars on holidays in Dubai, Singapore, Germany, etc.
It is a pity that out of more than 35 medical aid societies registered in Zimbabwe, only about five are performing to expectation. The viability of service providers is under threat. Strategic thinking is required lest we go into liquidation.
Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.
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