30 January 2013

Zimbabwe: Mixed Feelings Over Ban on Medical Societies

BENEFICIARIES of various medical aid societies have expressed mixed feelings over Government's intended ban of societies that are not complying with regulations governing their operations.

Some applauded the move as the only way to solve the impasse between the medical societies and service providers on payment. Others urged Government to look into some of the fees charged by the doctors, hospitals and laboratories.

"Why do these societies get people's monies every month and spend it on themselves? Is this not daylight robbery," said Mr Lovemore Mataranyika of Harare.

"When a practitioner claims for the services rendered they have the audacity to "blacklist" him or her, isn't this violating the patient's right to see a practitioner of their choice?"

Another beneficiary said: "I think that is a noble idea to have certain medical aid societies' licences revoked.

"We have gone to doctors, and have a situation where the doctor does consultation only. As for drugs, you pay cash.

Reason for this is that most of these medical aid societies do not pay."

Other people believe there are too many medical aid societies, hence the impasse between them and providers as others are after maximising profits.

According to the Association of Healthcare Funders of Zimbabwe , there are 29 societies, including three affiliate members.

Some of the societies are 'inhouse' medical aid societies while others are open societies.

According to AHFoZ, some employers are not remitting contributions to the societies and this has affected mainly inhouse societies.

Others shun 'extortionist' fees charged by some providers in preference of those with reasonable charges. In response to this trend, CIMAS, one of the leading medical aid societies, has introduced what it calls cost rationalisation guidelines.

According to the medical aid society, the rationalisation is meant to ensure that the fund continues to meet its financial obligations.

"It has also been noted that in Zimbabwe the average stay for major illnesses in hospital is longer compared to international trends," said CIMAS in a statement.

AHFoZ chief executive officer Mrs Shylet Sanyanga said she was not sure whether or not CIMAS' analysis was common among other members. She said when such a big society decides to take such measures it would have identified a problem.

Some of the CIMAS guidelines include two days stay in hospital unless the attending doctor proves the need for the patient to stay longer and only three visits to emergency and casualty units per beneficiary per year.

Government issued a two months ultimatum to the majority of medical aid societies to pay up service providers.

This comes as the Competition and Tariff Commission has ordered CIMAS to honour and reimburse all medical claims made by its members for dialysis procedures done at a private hospital.

According to the Government Gazette of January 25 2013, CIMAS should desist from directing its members from dialysis procedures to a specific service provider, saying it was contrary to the public interest.

CIMAS has been refusing to pay claims of dialysis services offered at a dialysis centre in Harare, directing its members to Harare Haemodialysis Centre where it has a controlling stake.

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