The rocketing fees of private medical practitioners and
providers of private medical services, who are all tracking their fees against the US dollar, has created
problems within medical aid societies and among their members as they battle to
match medical fees, but pricing many out of medical aid.
To offer full coverage, which is what is needed if doctors,
hospitals and pharmacies are ready to accept cards, medical aid societies have
to charge ever higher subscriptions, also based on the exchange rate or look
for other solutions, such as managed health care, where costs can be reduced by
having the societies’ own facilities and have doctors on salary.
With the latest increases in fees, medical aid societies
are switching to tracking the official auction rate in their subscriptions, but
this can produce monthly bills close to five figures for an average family, and
far more than most families can afford.
The crisis has now reached one of the largest two
societies, Premier Service Medical Aid Society (PSMAS), which covers many civil
servants and others in the public sector, although people outside this sector
can join.
But the high subscriptions required for full private
coverage are not affordable by members and PSMAS has been moderating rises. But
that means its payments are far below what doctors charge.
As a result, all members on PSMAS main plan and all other
members on non-private plans will be asked to pay cash upfront when seeking
services from doctors with immediate effect.
In his latest update to fellow doctors, Zimbabwe Medical
Association secretary general Dr Sacrifice Chirisa said the latest position on
PSMAS was influenced by the ‘sub economic’ reimbursement the Society was making
to doctors, equivalent to US$1 at the current official rate he claims.
“In order to ensure sustainability of (ZiMA) members, all
PSMAS main and all non-private sector plan members will be asked to pay cash
with immediate effect as the reimbursement is sub economic,” said Dr Chirisa.
Responding to the latest position by doctors, PSMAS public
relations officer Ms Tsitsi Chawatama attributed the low tariffs being
reimbursed to doctors to low subscriptions being paid by members.
She said PSMAS was currently charging subscriptions lower
than what service providers, who are tracking the US dollar rate, were charging
resulting in huge shortfalls and currently, cash upfront policy by service
providers.
“Consequently our members have been experiencing shortfalls
due to the high costs of healthcare as a result of the hyper-inflationary
environment,” said Ms Chawatama.
She said PSMAS will, however, continue consulting all
stakeholders in order to find a solution that serves the interest of members
whilst also ensuring sustainability of the service providers and medical aid
funders.
PSMAS, more than most societies, runs its own medical
facilities as part of reforms in the 1990s as it moved towards managed health
care, that is a system where members have to use the providers facilities,
cutting their choice, but in return getting cheaper cover.
Association of Health Funders of Zimbabwe (AHFOZ) chief
executive officer, Mrs Shylet Sanyanga urged employers to take up medical
obligations for their staff as salaries remain subdued arguing that medical aid
was a tax deductible expense.
She also called on employers to remit their subscriptions
on time to medical aid societies so that they can in turn reimburse service
providers on time.
“As AHFoz we are aware of the challenges that are being
experienced by all the players in the healthcare system, which are mainly due
to the prevailing macro environmental factors.
“However we strongly encourage employer organisations to
continue supporting employees’ healthcare needs by paying viable contribution
rates on time, so that medical aid societies can also pay healthcare service
providers on time, before the money completely loses value,” said Mrs Sanyanga.
Commenting on the latest revision of subscriptions by the societies, Mrs Sanyanga said AHFoz only
provides a guideline which societies could use to negotiate with employer
organisations.
“The AHFoz tariff is binding on the upper limit, therefore
individual funders may negotiate fees affordable to them with willing
healthcare providers,” said Mrs Sanyanga.
Asked on progress regarding development and implementation
of a scientific tariff, which is expected to give birth to a ‘fair charge of
medical services’, Mrs Sanyanga said development was complete and will be
implemented from 1 August 2020.
The scientific tariff was promulgated by accusations that
doctors were overcharging for their services. Herald
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