Published by the government of Zimbabwe
20 September 2008
editorial
Harare — MEDICAL aid, especially with the huge extension of coverage to most commercial and industrial workers in the early years of independence, has been a major funder, second only to the State, of Zimbabwe's medical facilities.
But medical aid is now on the verge of collapse, leaving the majority of those in formal employment high and dry when it comes to paying medical bills.
Members of the majority of schemes, working on fee for service, now have to pay almost all the bills charged by doctors, dentists, pharmacies and hospitals. In fact, most "service providers" now want to be paid up-front with the member claiming back.
By the time the same claim is processed, inflation has eaten into the already modest refund, making it almost worthless.
The major managed health scheme. PSMAS, which pays its own medical staff and which owns clinics and other facilities, is not going to cope for too many months more on 50c subscriptions from civil servants.
Raising subscriptions is possible, but there is one serious limit. Most members have to pay from the previous month's salary, while doctors and hospitals are charging this month's fees.
The shortage of medical staff in the country has also led to a situation where it is difficult to control the fees charged by professionals.
Medical aid systems can collapse in times of high inflation. This happened in Zambia during that country's time of hyperinflation and it is only now that serious efforts are being made to start medical aid again.
There was less urgency to preserve medical aid there, than in Zimbabwe, because the mines and other major employers had their own in-house medical staff and facilities and these effectively covered the bulk of the formal workforce.
Zimbabwe's medical aid societies have struggled to keep something going, but they are nearing the end of the line.
Unless the currency stabilises soon, there will be need for a major rethink about what can be done and what cannot be done.
Since medical aid subscriptions have to be kept as a modest percentage of most people's salaries - which, it must be stressed, reflect the previous month's earnings, not what they are going to be paid at the end of the month in which they make their claim - some hard choices will have to be faced.
Societies can continue paying small percentages of all medical bills, or start looking at making medical aid more like car and household insurance, just paying for the most costly procedures while leaving members uninsured for most routine medical bills.
This would mean that members would have to pay the full cost of things like visits to general practitioners and most pharmaceutical drugs, but would be able to carry almost full insurance for things like surgery and other more complex procedures.
The choice will be between medical aid carrying a small percentage of the cost of everything, or a large percentage of the cost of small number of things.
This would wipe out the gains made since the first benevolent medical societies were formed around a century ago.
In these early days, routine medical bills were not covered; the societies were there to help with the sort of illnesses that could easily bankrupt an ordinary skilled worker.
The reasoning is that while most people fall ill sometime during a year and need to see a doctor, far fewer need surgery, casualty treatment or special treatment for cancers and the like. So what was insured was the unlikely but expensive illness, rather than the cheaper but more common illness.
As the economy stabilises, it will then be possible to add to the emergency benefits and start restoring the full range of benefits so many enjoyed for so long.
But the emergency schemes would, at least, offer real insurance for the most critical areas, which would be a real benefit rather than the almost negligible benefits offered now.
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