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Health Talk: Deal with wayward medical aid societies

The triad of patient care in Zimbabwe bases mainly on the service provider, the patients themselves and the health insurer who should team peacefully to deliver the best health care service.

Unresolved disputes can end up in acrimonious relationship which may have potential to affect third parties in life.

The triad of patient care in Zimbabwe bases mainly on the service provider, the patients themselves and the health insurer who should team peacefully to deliver the best health care service.

Service providers have often pointed fingers at Medical Aid Societies which on numerous times have shown great pomposity and bully behaviour when it comes to issues of honouring claims, registering service providers and setting tariffs.

Why is it that the regulator does not take stern action against some of the errant Medical Aid Societies that continue to flout basic regulations and workplace ethics?

On August 8, 2023, Ngezi-based doctors reported Cellmed Medical Aid Society to the Competition and Tariff Commission for what they called unethical practices.

Cellmed has been accused of arbitrary tariff reductions, anti-competitive behaviour, unfair business practices, unfair competition and it is time that the regulator and the Competition and Tariff Commission take action against such behaviour.

Zimplats employees are on Cellmed Medical Aid Society and it is absurd that the Medical Aid Society pays only US$5 to doctors as initial consultation and the balance of US$20 is supposed to be covered by the patients.

The Medical Aid Society claims that it will reimburse the US$20 that the patient will have paid as shortfall.

All this is a way to discourage patients from seeking medical assistance from the service providers of their choice.

These reductions of tariffs are a blatant disregard of service level agreements with regard to Association of Health Funders of Zimbabwe’s fee structure.

The anti-competitive behavior exhibited by the same Medical Aid Society is not only nauseating but piquing. 

New medical practitioners who have sought to register with Ngezi Platinum Mine have been refused the chance to join the claims platform, thus effectively monopolising the market.

The subsequent lack of competition inhibits market dynamics, stifles innovation and compromises patient access to a wide range of specialised healthcare services.

The unfair business practice exhibited by Cellmed by failing to register new medical practitioners in Ngezi should be condemned by all sober-minded people in this country.

Patients are then shunted to its own units, all this being driven by the fact that medical aid societies have now delved into service provision.

We hope the Health Service Bill will bring closure to this contentious issue which has remained dormant for a time immemorial.

If a medical aid society behaves arrogantly, I wonder why organisations rush to insure their workers with the same entity that does not allow its members to seek medical attention from doctors of their choice.

In Bulawayo, one doctor was denied claims registration by Bonvie because the doctor used to work for Bonvie Medical Aid Society.

What it means is that the medical aid society is worried there may be competition as members may end up flocking to the doctor.

Such monstrous behaviour should be damned to the last. I am not sure why some of these medical aid societies portray themselves as untouchable yet they should honour their obligations in the medical industry.

It is a pity that patients are caught in the melee and they are the final losers as they experience double financial “pashashe”.

The monthly premiums have been increased significantly; the cost of healthcare has sky-rocketed and service providers end up requiring cash up-front.

As service providers, we would not be charging shortfalls if Medical Aid Societies would honor their payments within the stipulated time.

For long, service providers have often been taken for a ride by some errant medical aid societies, but we will stand firmly to defend our profession lest we go into irreversible extinction.

The regulator should take action against aberrant medical aid societies otherwise the cries will last forever.

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