More than 1,3 million access Cimas health facilities

Cimas Medical Aid Society group operations executive Vulindlela Ndlovu today (Tuesday) revealed that more than 1,3 million people have made use of Cimas health facilities countrywide in the last five years.  

Mr Ndlovu was responding to a question raised before the Parliamentary Portfolio Committee on Health and Child Care on why medical aid societies were spending money on investments in clinics and other facilities when members were incurring shortfalls when accessing medical services and doctors were not being paid gazetted tariffs.

He said the setting up of the health facilities was a response to a call from members of the medical aid society to create such facilities.

He also said investments in most of these facilities were investments that were set up prior to dollarisation, when the economy was different and when the claims loss ratios were much lower than currently

Moreover, he said, financing for these was not directly from the member's current contributions but rather from reserves. The funds had been built up over the 70 years that Cimas has been in existence.

Legally funders are required to maintain accumulated reserves of at least 25% of current contributions.  The reserves are represented by assets held and these are mainly liquid assets but Cimas  also invested in property and to a lesser extent the stock market, he said.  

The health facilities that Cimas has had as far back as 1985 had also generated surpluses that have been reinvested.

Mr Ndlovu also revealed that attendances at the Cimas facilities had gone up by 13 percent in the last year before the recent addition of more facilities.

"The picture is bigger this year after adding another facility that is open 24 hours," he said.

Cimas Medical Aid Society recently opened another clinic in Harare along Fourth Street which is open for 24 hours. Even more recently it opened yet another clinic at High Glen Shopping Centre in Budiriro.

Mr Ndlovu said that even with the facilities provided by Cimas, members were free to seek services elsewhere as Cimas paid general practitioners for seeing its members.

The issue of quality of service from the medical aid societies was also raised with concerns that quality was being compromised in the sector.

"Cimas takes quality seriously," Mr Ndlovu said.

"We benchmark our service to international standards. For instance, to my knowledge our laboratory is the only medical laboratory that is ISO certified in the country. The issue of quality for us is important," he said.

The Association of Healthcare Funders of Zimbabwe (AHFoZ) was asked by members of the committee what it was doing to mitigate the fraudulent behaviour that it was alleged some health service providers were engaging in.

AHFoZ chairman Cecilia Nyamutswa  had told the committee that there had been an increase in fraudulent claims.

Mrs Nyamutswa said doctors and even ordinary people had in the past been taken to court over fraudulent behaviour. She said doctors who were found to be fraudulent were blacklisted so that no funder would use them as a service provider. She also said AHFoZ had a risk committee that was there to look into such issues.

The committee chairman, Dr Ruth Labode, urged AHFoZ to look into some of the issues that were raised by the committee.
She called on medical aid societies to look into the issue of drugs for members with chronic diseases who might find that their drug benefit for the year had been fully utilised when they still required drugs for several more months before the year ended.

She also suggested that they come up with a way of reserving the medical contributions of those who might not have made many claims over decades of paying membership subscriptions but in their old age needed medical treatment and still faced shortfalls.

She suggested that if benefits were preserved for those who did not make claims, this might held stop abuse.

 "Look at new models," Dr Labode suggested.

Asked about the future of medical aid societies in the next three years, Mrs Nyamutswa said everything was dependent on the economy.
"Whatever happens to the economy determines what happens to us. If there is no change in the economy then we are not growing," she said.

She suggested that, if there was no change in the economy, the only avenue for membership growth would be to find ways of encouraging those in the informal sector to join medical aid societies.