Staff Writer
The healthcare sector has been challenged to adopt a culture change and a change of priorities so that people embrace a culture of investing in health through taking medical aid cover instead of prioritising investing in burial.
Association of Health Funders of Zimbabwe (AHFoZ) chief executive Shylet Sanyanga at the association’s 2024 annual conference recently said before being buried, people should live full productive lives.
“In Zimbabwe, there are different medical aid societies and different products to suit different budgets. While we focus on burial, other countries are trying to respond to a problem of longevity, whereby their populations are living as centenarians.
“Let us all play our part in looking after ourselves and living full, fulfilling lives. Health is the first wealth,” she said in her speech.
The convention is an annual event where the healthcare sector meets to discuss issues affecting the healthcare sector after realising that there was a need to focus on healthcare outcomes in the healthcare value chain.
Sanyanga said over the years AHFoZ encourages its members to utilise member contributions according to International Best Practice, whereby 80% should be utilised on paying healthcare claims, while 20% may be used for non-healthcare costs, being 5% for statutory reserves and 15% administration.
“Maintenance of 25% liquid reserves is an important compliance issue that may impact the renewal of practicing licenses for medical aid societies,” she said.
She noted that the introduction of the Zig brought a fresh breath of life, as one of the major challenges was that medical aid societies could not keep pace with the exchange rate-related fee changes as they could not adjust contributions at the same pace as the informal market rate.
Medical aid societies are required to give prior notice to their members on any pending increases in contributions.
However, according to Sanyanga, members and employer organisations are not always able to absorb proposed increases.
“This often results in a mismatch, which causes shortfalls. It should be noted, however, that there are other causes of shortfalls, such as exhausted annual global limit/benefits, suspended membership, exchange rate mismatch, the difference in fees charged by the provider, and the AHFoZ Tariff,” she said.
She added that another major cause for shortfalls is when medical aid subscriptions are pegged below actuarially recommended rates; in such instances, the healthcare funder will be collecting subscriptions that are not enough to cover the claims costs.
“Its liquidity status will not be able to absorb the fees expected by service providers.
“The Healthcare Funder aid will therefore reimburse at levels affordable to it, leaving the balance to be collected by the service provider as a shortfall at the point of care,” said Sanyanga.
On the other hand, she noted that it is important for member organisations or individual members to remit the billed contributions on time to avoid inconveniences of card rejections at the point of care.
Sanyanga said with regards to medicines being among the top claimants, AHFoZ and the pharmaceutical sector should engage with a view to agree on a system such as “single exit price” or agree on acceptable “mark-ups” throughout the chain, from the wholesaler/manufacturer to the end user.
“This would eliminate the problem whereby medicine prices can go up tenfold before reaching the consumer,” she said.
On the other hand, she said AFHoZ urges members to invest in mental health issues in terms of prevention, treatment, and rehabilitation.
“Some of the costs for mental health cases are indirect, as patients may present with physical illness complaints. Mental wellbeing forms the basis of physical, social, and economic wellbeing,” she said.
Regarding accreditation of new facilities, Sanyanga said most of the hospitals being built are small facilities that offer limited services.
“We believe that big facilities offering “one stop shop” services with “state of the art” specialist hospitals would be ideal as they would provide the patient convenience and would help attract medical tourism whilst reducing outward bound medical tourism.”
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