Regulator should act on errant medical aid societies

Why is it that the regulator does not take stern action against some of the errant MAS that continue to flout basic regulations and workplace ethics?

UNRESOLVED disputes can end up in an acrimonious relationship which may have the potential to affect third parties.

Patient care in Zimbabwe is based on the triad of the service provider, the patient and the health insurer who should all team up peacefully to deliver the best healthcare service. Service providers have often pointed fingers at medical aid societies (MAS) which on numerous occasions have shown great pomposity and bully behaviour when it comes to issues of honouring claims, registering service providers and setting tariffs.

Why is it that the regulator does not take stern action against some of the errant MAS that continue to flout basic regulations and workplace ethics?

On August 8, 2023, Ngezi-based doctors reported Cellmed Medical Aid Society to the Competition and Tariff Commission for what they called unethical practices. Cellmed has been accused of arbitrary tariff reductions, anti-competitive behaviour, unfair business practices, unfair competition and it is time the regulator and the Competition and Tariff Commission took action against such behaviour.

Zimplats employees are on Cellmed Medical Aid Society and it is absurd that the medical aid society pays only US$5 to doctors as initial consultation and the balance of US$20 is supposed to be covered by the patients. The medical aid society claims that it will reimburse the US$20 paid by a patient as shortfall. All this is meant to discourage patients from seeking medical assistance from service providers of their choice.

These reductions in tariffs are a blatant disregard of service level agreements with regards to Association of Health Funders of Zimbabwe’s fee structure.

The anti-competitive behaviour exhibited by MAS is not only nauseating, but piquing. New medical practitioners who have sought to register with Ngezi Platinum Mine have been refused the opportunity to join the claims platform, thus effectively monopolising the market. The subsequent lack of competition inhibits market dynamics, stifles innovation and compromises patient access to a wide range of specialised healthcare services.

The unfair business practice exhibited by Cellmed by refusing to register new medical practitioners in Ngezi should be condemned by all sober-minded people in this country.

Patients are then shunted to its own units, all this being driven by the fact that MAS have now ventured into service provision. We hope the Health Service Bill will bring closure to this contentious issue which has remained dormant for time immemorial.

If a medical aid society behaves arrogantly, I wonder why organisations rush to insure their workers with the same entity that does not allow its members to seek medical attention from doctors of their choice?

In Bulawayo, one doctor was denied claim registration by Bonvie because the doctor used to work for Bonvie Medical Aid Society. What it means is that the medical aid society is worried there may be competition as members may end up flocking to the doctor. Such monstrous behaviour should be damned to the last.

I am not sure why some of these medical aid societies portray themselves as untouchable, yet they should honour their obligations in the medical industry.

It is a pity that patients are caught in the melee and they are the final losers as they experience double financial loss. The monthly premiums have been increased significantly, the cost of healthcare has sky-rocketed and service providers end up requiring cash up-front.

As service providers, our patients would not be incurring shortfalls if medical aid societies honoured their payments within the stipulated time.

For long, service providers have been taken for a ride by some errant MAS, but we will stand firm to defend our profession lest we go into extinction.

The regulator should take decisive action against aberrant Mas, otherwise the cries will last forever.

  • 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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