“It is not
about a specific provider, but we envision a situation where a medical
insurance company does not end up providing health services or selling
pharmaceutical products,” said Deputy Minister Kwidini, responding to concerns
by health services providers about some insurance companies which pay for
patients care and seek to provide health services.
“This has its
own challenges that deprive patients of the right to choose a provider of their
choice. We are seized with the matter and we are working on finding a solution
that best serves our health system,” he said .
The president
of the Medical and Dental Private Practitioners of Zimbabwe Dr Johannes Marisa,
had outlined, in a letter to the Deputy Minister, several issues faced by
healthcare providers in their dealings with some local health insurance
companies.
This, critics
argue, creates an inherent incentive for health insurance companies to
prioritise profit over patient welfare.
What is termed
managed health care emerged in Zimbabwe within the ambit of non-profit medical
aid societies trying to contain costs by having their own doctors, clinics and
pharmacies available for members to use freely.
The two largest
non-profit societies, PSMAS, which largely handles Government workers, and
CIMAS, both embraced the concept to some extent, with PSMAS taking it furthest
in a bid to contain the monthly subscriptions.
The idea was
then taken up by some of the for-profit insurance companies that now own and
manage their own health centres, with those insured often told that they can
only receive free consultation by going to the company clinic and doctors.
With concerns
from those outside the systems, the envisaged changes to the current practice
in Zimbabwe are based on the fundamental principle that the primary goal of an
insurance company is to generate profit for its shareholders, while the primary
goal of a healthcare provider is to deliver the best possible care to patients.
When these two
roles are combined, several unethical risks emerge, said Deputy Minister
Kwidini.
Dr Marisa’s
letter highlighted what he described as “unethical and unfair practices” by
some named companies, which he claims have adversely affected service providers
and patients alike.
Key issues
raised include the refusal to register new service providers, unilateral
reductions in tariffs and higher drug prices at the health insurance-owned or
affiliated pharmacies compared to non-affiliated pharmacies.
Dr Marisa also
noted that many practitioners have been deregistered for minor infractions,
further complicating access to care for patients.
Deputy Minister
Kwidini acknowledged the concerns raised by practitioners and emphasised the
Government’s commitment to creating a fairer healthcare landscape.
“We are
actively working to ensure that all health insurance providers adhere to
ethical standards that prioritise patient choice and fair compensation for
service providers,” he said.
In the coming
weeks, the Ministry of Health and Child Care is expected to hold consultations
with stakeholders in the sector to further discuss these issues and explore
workable solutions.
Critics argue
that an insurer-owned service provider network might be incentivised to deny or
limit expensive but necessary treatments, tests, or specialist referrals to
keep costs down and maximise profit.
They say the
medical decision is no longer purely in the hands of a doctor focused on
health, but also influenced by a corporation focused on its bottom line.
Further, the
insurer could create financial incentives or barriers that “steer” patients
towards their own facilities and away from independent, possibly higher-quality
options. This limits patient choice and can lower the overall standard of care.
Herald
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