Patients suffer as doctors, medical aid societies clash

A TUSSLE has erupted between medical practitioners in the private sector and medical aid societies, as doctors are accused of turning down policy holders without cash co-payments due to health funders' failure to settle claims.

Medical practitioners who spoke to the Zimbabwe Independent had no kind words for medical aid executives, whom they said lived lavishly from clients' premiums.

The doctors said patients could barely afford medical bills since the cost of living continued skyrocketing. Patients are left with no option, but to turn to private doctors because the public health system is in a shambles underpinned by an acute shortage of medical equipment and medicines.

Health funders, doctors added, were failing to meet the demand for cover despite clients religiously paying subscriptions. This has complicated the situation, as medical doctors are forced to demand cash upfront from patients.

Medical and Dental Private Practitioners of Zimbabwe Association president Johannes Marisa said they preferred payments in foreign currency.

"Private doctors are charging co-payments in foreign currency to ensure they remain viable and sustain operations in the medical industry," Marisa said.

"It is unfortunate that medical aid societies are not paying health covers yet they are collecting monthly contributions from their clients."

He went on: "Almost half of health funders don't want to own up to their obligations to pay service providers. Survival of the private medical practice is hanging by a thread because some doctors have to fund for their own personal protective equipment and meet other costs of running hospitals."

He blasted medical aid societies managers for driving top-of-the-range cars at a time patients' needs were not met.

"The medical aid managers are the ones benefiting from the scheme as they are misusing funds for personal benefits. It's not the doctors' fault. For those few that own up to cover their clients, they pay in local currency which does not match with black market exchange rates in the United States dollars."

Patients, however, have complained about doctors' demand for foreign currency.

Some patients have petitioned private doctors to meet medical aid societies and resolve the issue.

Zimbabwe Senior Hospital Doctors Association president Shingai Nyaguse said the public must be educated on medical aid societies.

"Unfortunately the public tends to blame doctors on failed health insurances. Several medical aid societies are using clients' monthly subscriptions for personal benefits like hefty packages. Medical aid generally pays well below the agreed tariffs, hence the shortfalls," he said.

Zimbabwe Medical Association (Zima) tariff liaison committee chairperson Shingirirai Meki said doctors used best international practices to determine co-payments.

"I want to highlight the fact that medical aid payments and doctors failing to get their money on time has been happening for a longtime. However, over the years, we have been trying to solve the matter for the benefit of patients," Meki said.

"If a medical aid has financial struggles, we might never know because it's not declared publicly. On what is being charged by doctors versus medical aid reimbursements, there are tariffs that come from doctors (Zima), while health funders pay from collections. What then is paid by a patient is the difference we call a shortfall or co-payment."

Meki said co-payment is charged to meet any outstanding amounts.

"As Zima, we stand guided by the Statutory Instrument that was gazetted by the government in 2014. The government then found a middle ground to set standard tariffs that we adhere to. It's unfortunate that some medical aids have failed to pay tariffs set by the government. Patients are not being ripped off; it's just that the medical aids sometimes fail to pay."

No comment could be obtained from the Association for Healthcare Funders in Zimbabwe (AHFOZ) this week as officials were buck-passing.

AHFOZ has previously said medical aid societies were adjusting contributions to match healthcare service provider rates and narrow shortfall gaps.