Medical aid mutiny as funders escalate fight against Bill

A major battle over the future of Zimbabwe's healthcare financing system is brewing in Parliament after the Association of Health Funders of Zimbabwe (AHFoZ) urged lawmakers to block proposed amendments to Statutory Instrument 330 of 2000, warning that the reforms could destabilise the medical aid sector and ultimately harm patients.

The matter is currently before the Parliamentary Portfolio Committee on Health and Child Care, which is considering submissions from stakeholders on the proposed changes.

AHFoZ has also petitioned Parliament over the issue, although the petition is yet to be formally tabled before the House.

At the heart of the dispute are proposed amendments that would prohibit medical aid societies from owning, managing or operating healthcare facilities and require them to dispose of their interests in hospitals, clinics and specialist healthcare units within a prescribed timeframe.

The proposed reforms are understood to be aimed at addressing concerns about potential conflicts of interest arising from the integration of healthcare funders and service providers.

However, AHFoZ argues that the amendments could have far-reaching and unintended consequences for healthcare delivery, affordability and the sustainability of medical aid schemes.

In a position paper submitted to Parliament last week, the association called for a more balanced regulatory approach.

"We respectfully propose a more proportionate, evidence-based regulatory approach that addresses legitimate conflict-of-interest and competition concerns without undermining Universal Health Coverage, affordability and system resilience," the submission states.

AHFoZ represents some of Zimbabwe's largest medical aid societies, including First Mutual Health, CIMAS, PSMAS, VIVAT and Parksmed.

According to the association, vertically integrated healthcare models developed over several decades as a practical response to challenges within Zimbabwe's healthcare system, including escalating medical costs, tariff disputes, shortages of medicines and limited healthcare capacity.

The association said medical aid societies invested in healthcare facilities to improve access to services, reduce treatment costs for members and provide greater predictability in healthcare financing.

"The proposed amendment seeks to reverse decades of a functional evolution without evidence of harm or failure," the submission argues.

AHFoZ warned that forcing medical aid societies to dispose of healthcare facilities could trigger distressed asset sales, weaken the financial position of medical aid schemes and reduce service capacity in an already strained healthcare sector.

The association further cautioned that the costs associated with restructuring could ultimately be passed on to members through higher contributions, reduced benefits and increased out-of-pocket healthcare expenses.

Beyond the economic implications, AHFoZ has raised constitutional concerns, arguing that the proposed amendments could infringe on property rights, freedom of association and access to healthcare if they are not shown to be reasonable, necessary and proportionate.

The association also questioned whether reforms of such significance should be implemented through delegated legislation rather than through a substantive Act of Parliament.

According to AHFoZ, there is currently no evidence that medical aid-owned healthcare facilities have monopolised healthcare delivery or caused harm to consumers.

The submission notes that the majority of healthcare services accessed by medical aid members continue to be provided by independent hospitals, clinics and healthcare practitioners rather than facilities owned by medical aid societies.

Instead of imposing a blanket ban on ownership, AHFoZ is advocating for targeted regulatory interventions designed to address governance and competition concerns without dismantling existing healthcare structures.

Among its recommendations are ring-fenced governance frameworks, independent audits, enhanced disclosure of related-party transactions, tariff oversight mechanisms, open-network access arrangements and stronger competition regulation.

The association has also called for a comprehensive regulatory impact assessment and broader stakeholder consultations involving patients, healthcare providers, employers, labour organisations and civil society groups before any final decisions are made.

The Parliamentary Portfolio Committee on Health and Child Care is expected to evaluate the submissions before making recommendations on the proposed amendments.

The outcome of the debate could have profound implications for Zimbabwe's healthcare system, determining how healthcare services are financed, delivered and regulated for years to come.

With medical aid societies, healthcare providers, policymakers and consumers all watching closely, the proposed reforms are shaping up to be one of the most significant healthcare policy discussions in recent years.