People on health insurance should brace for a considerable
increase in monthly contributions as efforts gather momentum to cushion them
against huge co-payments and shortfalls emanating from charges demanded by
service providers mainly in the private sector.
A new reference list compiled by the Association of Health
Care Funders of Zimbabwe (AHFoZ) is expected to see medical aid societies
reimbursing general practitioners a ceiling of $321,20 for initial
consultations by their members.
The medical aid societies are also expected to reimburse
specialist doctors an average of $1 000 for initial visits.
Although this reference pricing list, which became
effective on November 1 is likely to see an increase in members’ contributions
towards health insurance, stakeholders in the industry said if implemented, the
increases will ensure service provision with little or no co-payments and
shortfalls on patients, which has been the case of late.
AHFoZ chief executive Ms Shylet Sanyanga told The Herald
yesterday that medical aid societies were consulting with employers on the
practicability of the charges on the reference list.
“AHFoZ member societies are in the process of engaging
their respective member organisations on contribution increases for them to be
able to absorb a recent fee review recommended by AHFoZ effective, 1 November,
2019.
“Our hope as AHFoZ is to see a significant reduction or
elimination of shortfalls,” said Ms Sanyanga.
She said AHFoZ was also encouraging medical aid societies
to offer flexible packages.
“We are working towards eliminating the information
asymmetry pertaining to the relationship between the contribution level and the
prevailing costs. Contributing medical aid members should be made aware of how
much healthcare services are costing, in relation to the contribution, so that
they make informed decisions of package options,” said Ms Sanyanga.
She said AHFoZ had recommended to its member societies that
they should identify and establish networks with cooperating service providers.
The providers will then form a pool to work with the
insurers.
Some medical aid societies have since adjusted their member
contributions to at least $450 per member per month, in line with the new AHFoZ
recommendations.
Zimbabwe Medical Association (ZiMA) chairperson for the
national tariff liaison committee Dr Shingirirai Meki welcomed the development
saying if honoured, they will address challenges of huge co-payments and
shortfalls.
“If implemented, this will bring a huge relief to patients
by alleviating shortfalls especially on consultations and basic care,” said Dr
Meki.
He said the reference list was also likely to bring back
sanity in pricing of health services.
Dr Meki said pricing of health services was guided by a
2014 Government Gazette, which pegged consultation fees for general
practitioners at US$35 a visit and about US$70 for specialists.
“Some providers were then converting these figures to the
prevailing interbank rate of the day. There was, however, no uniformity on the
pricing,” said Dr Meki.
Of late, medical aid societies had lost their relevance as
patients had to grapple with huge co-payments and shortfalls as a result of
high costs being charged by service providers.
Although service providers had increased costs, health
insurers could not increase member contributions, which subsequently leads to
increased reimbursements to providers as salaries for most members had also not
been adjusted. Herald
0 comments:
Post a Comment