Medical aid societies invite debate on proposed regulatory body

The Association of Healthcare Funders of Zimbabwe (AHFoZ), which represents the country's medical aid societies, is holding a breakfast meeting at Harare's Monomotapa Hotel on Friday (December 9) to discuss the proposed establishment of a regulatory authority for medical aid societies.

The association has invited to the breakfast meeting members of the Parliamentary Portfolio Committee on Health and representatives of the Ministry of Health and Child Care, employers, employees, consumers, hospitals, doctors and other health service professionals, as well as members of AHFoZ.

A panel, which will include representatives of some of the key stakeholders, will lead discussions on the Ministry of Health and Childcare's proposal to establish, by an Act of Parliament, a regulatory authority for medical aid societies.

The proposal for establishing an authority to regulate medical aid societies follows the continued impasse between medical aid societies and health service providers over tariffs and allegations earlier this year that some medical aid societies had failed to consistently pay healthcare providers on time.

There has been no agreement between healthcare funders and service providers on tariffs for more than a decade.

AHFoZ has welcomed the proposals for a regulatory authority, if it protects the interests of all parties concerned, in particular the interests of medical aid societies and their members.

It would like to see the annual licensing of medical aid societies revisited, due to the uncertainties that annual registration creates, with robust supervisory structures being put in place instead to ensure all stakeholders are protected and signs of distress are identified at an early stage. It suggests this could be achieved through off-site or on-site examinations to ensure a medical aid society's viability.

It suggests that the role of the proposed regulatory authority should include the protection of the interests of medical aid societies and their members from what it calls "errant healthcare providers" and enforcement of agreed ethical practices by medical aid societies, their members, and healthcare providers, as well as fair adjudication of complaints in relation to medical aid societies.

In a position paper sent to those it has invited to Friday's breakfast meeting, AHFoZ proposes that members of the authority should include representatives of medical aid societies' and healthcare providers' associations. Any healthcare practitioners appointed to the authority should, it says, be retired non-practising individuals.

It says the proposed Act of Parliament should encourage a business environment that is conducive for all participants in the healthcare delivery chain. Its application should not be onerous for medical aid societies but should create an environment where local and international entrepreneurs are encouraged to establish medical aid societies and enhance the provision of healthcare in Zimbabwe.

AHFoZ does not believe gazetting price controls is an efficient mechanism for dealing with the longstanding stalemate over tariffs. It proposes that a scientifically arrived at national reference tariff aligned to the national health policy be agreed to by all stakeholders. It advocates the engagement of actuaries, health economists, accountants and other consultants to ensure calculation of the reference tariff is economic and scientific and takes into account issues of affordability and international pricing standards.

This would mean the authority would not need to superintend or mediate tariffs. There could be price competition within the national reference tariff guidelines. Service providers and medical aid societies could, within the tariff band, negotiate discounts and premiums. Such competition would encourage better service delivery and a more effective reimbursement system.

AHFoZ would also like to see the proposed Act encouraging the operation of codes of practice and allowing service level agreements between medical aid societies and healthcare providers.

It advocates provision for the authority to issue corrective orders to enforce compliance, with a reasonable period being allowed to become compliant, and clearly defined circumstances in which deregistration or cancellation of a licence would occur.

With medical  aid societies having in recent years experienced an increase in fraudulent activities by both medical aid society members and healthcare providers, AHFoZ would like to see the proposed Act introducing mechanisms to protect medical aid societies from such behaviour.

The Act should, AHFoZ says, enhance the relationship between medical aid societies, healthcare providers and medical aid society members, while balancing the interests of each.