13 June 2014

Zimbabwe: Medical Fees: One-Way Approach Not Ideal


Medical aid societies face a difficult choice following the gazetted increases in fees that general practitioners and specialists may charge; either they raise their subscriptions to members so they can afford to pay these new fees or they keep payments to doctors at the old levels and expect their members to pay the difference in cash.

The choice they do not have is to meet the new fees and keep the old subscriptions. This might be possible for the odd rare treatment. But doctors fees form a large component of what medical aid societies spend so it is not a cost that can be absorbed.

The Association of Health Funders of Zimbabwe has sought legal advice and found that in effect the new fees are the maximum that they can pay doctors and that they can pay less. We assume that by the same token doctors can charge the new fees but will have to collect a large co-payment from their patients if the societies are not going to meet claims for the whole of the new figures.

This is largely what was happening for many before the new changes. Several doctors, especially those with reasonable experience and who were prepared to spend a bit of time with a patient were able to charge more than a young doctor trying to process 12 patients an hour. Quite a few people were ready to find an extra few dollars for what they considered a better doctor.

The virulence of the Zimbabwe Medical Association over the stance of those societies who are keeping the old subscriptions and the old payments is difficult to fathom. The ZMA is a purely voluntary association, the professional regulator of doctors being the Health and Allied Professions Council, so it is not necessarily fully representative of all doctors.

We hope the attack they have made does not imply that doctors want more patients, even if they are not really ill. Few people, at least those earning the sort of salary that a member of a medical aid society must earn to join a scheme that accepts the principle of fee for service, will not find US$15 to see a doctor if they are really sick, while many will want to think twice if they just have a sniffle.

Doctors attacking the societies might want to remember that pay for most people is largely frozen at the moment and any increases are very small. A big jump in medical aid subscriptions will cut take-home pay.

Societies could, however, be more flexible and give members a choice. One scheme could be based on present subscriptions. This would require large co-payments for consulting a doctor but give far fuller coverage for treatment. This would be a bit like some car insurance schemes whereby the insured owner has to pay for small repairs but gets the big ones properly covered.

It is a valid way of operating insurance, letting the insured person pay the affordable bills while racing into action over the really expensive, but far rarer bills.

A second scheme would pay all bills. Subscriptions would obviously be higher and in our opinion quite a bit higher. As many in the business have noted, co-payments tend to moderate abuse since people will think twice about spending US$10 to get a sick note they do not really need, but find the money if they are genuinely ill.

But with two schemes, properly costed, members could choose how much they wanted to pay for their health insurance and those paying less would have to accept that they were not getting 100 percent insurance, at least for doctors' consultations.

In this discussion between members and managers of schemes over what level of subscription is required for a stated level of benefits we would rather doctors kept a low profile. They have won their point; we agreed when Health and Child Care Minister Dr David Parirenyatwa set the new figures that doctors largely deserved the award.

No one is disputing that the new fees have to be paid. But now doctors need to leave the insurers and the insured to work out the nitty gritty of just how these new fees are to be met and not try to have imposed some ideological solution that one size fits all.

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