Staff Writer
HARARE: The regulation of Medical Aid Societies in Zimbabwe is sadly inadequate, according to Itai Rusike, Executive Director of the Community Working Group on Health (CWGH).
In a statement, he said the Ministry of Health and Child Care (MOHCC) lacks the capacity to effectively regulate these societies, and the proposed new bill aimed at creating a Regulatory Authority should strive to address this.
He said one major concern is the conflict of interest within the MOHCC, where some regulators are also providers of care who benefit from the same Medical Aid Societies they are supposed to regulate.
“Separation of functions is very weak for example two of the biggest Medical Aid companies in the country are both fund managers and providers of care making it difficult for them to focus on their core business of pooling resources and purchasing services on behalf of their clients.
“While the idea was to minimize care but that has since been abused. Small medical aid providers have lost business as a result as the small trickle of patients that come their way who are mostly uninsured or under-insured and are having to be charged exorbitant fees to compensate for the small numbers,” reads part of the statement.
He added, “We must understand that health care is not like an ordinary good such as bread or drinks where one can make a choice of either to consume or not and when to consume those goods.
“Sickness always comes unexpectedly and when sick, people have no freedom or luxury to make choices – what they want is care and nothing else – this desperation is then taken advantage of by providers of care,” he said.
Rusike noted that there are too many pools (Medical Aids) as this was encouraged by the Competition and Tariff Commission to increase competition in the sector in order to trigger increased quality and lower prices.
However, Medical Aids through AHFOZ seem to be operating as a cartel. In essence the market has an oligopoly where a few players are dominating the market.
Price/Tariff Setting – this is where we are not getting it right – be it pharmaceutical products/services, clinic/hospital services or other ancillary services.
“I mean we need a Commission to look at the entire medical services value chain on What is informing our prices? and what is informing our interventions.
“We also need a full costing of clinic/hospital interventions – when a doctor manages a cervical cancer patient for example – how much does it cost to do so?,” said Rusike.
He noted that the country should have a well-defined and costed minimum benefit package and this should be given by providers irrespective of sector public/ private at the stipulated cost.
“There is quite a lot of profiteering going on in the medical aid sector by a few powerful providers,” he said.
Rusike noted there is need for a well-defined and well-crafted National Health Insurance.
Key Recommendations:
- Strengthen regulation of Medical Aid Societies through the proposed Regulatory Authority
- Separate functions of regulators and providers of care
- Implement a well-defined and costed minimum benefit package
- Establish a Commission to investigate price-setting in the medical services value chain
- Develop a National Health Insurance scheme to address the country’s healthcare challenges
By implementing these reforms, Zimbabwe can work towards a more equitable and sustainable healthcare system that prioritizes patient needs over profits.
