Source: MedAid: Doctors, ZiMA on warpath •‘We won’t reject medical aid users’ •Moves underway to avert crisis | The Herald June 18, 2016
Paidamoyo Chipunza Senior Health Reporter—
Private doctors will not stop treating patients on medical aid despite a call by their mother body, the Zimbabwe Medical Association (ZiMA), to only accept cash-paying patients with effect from July 1. The doctors said they enjoyed good working relations with some medical aid societies that never defaulted in settling claims and ditching their clients would be unprofessional.
In separate interviews yesterday, most doctors distanced themselves from ZiMA’s position. “The current impasse was necessitated by the increase in tariffs effected by the Health Ministry in 2014, which saw costs of a general practitioners going up from $20 to $35 a visit. You might remember that this tariff was disputed by almost all medical aid societies arguing that it was not viable.
“Some of us therefore did not increase our consultation fees to that $35 despite it having been gazetted by Government. We continued charging $20, others were even charging as little as $15 a visit and our claims were being honoured as such,” said a doctor from Glen View, Harare, who spoke on condition of anonymity.
According to the doctor, it was this new tariff, which some doctors had effected and were invoicing patients that Zimra calculated its dues from, yet 90 percent of medical aid societies continued reimbursing doctors at the old tariff. Another doctor who called in from Rusape, said while some medical aid societies were taking long to honour claims, the majority of them eventually pay up.
“I am sure you will agree with me that when Government gazettes a tariff of $35 for general practitioners, another doctor operating from the heart of the country would chose to charge $40 simply because of his location while I continue to charge maybe $25 also because of where my surgery is located.
“So basically, those who are feeling the pinch by Zimra are those doctors who are normally expensive and funders cannot reimburse them at the rate they want,” she said. The doctor also said equally, there were some bad health insurers who were taking more than 60 days to settle claims with service providers.
“You will, however, realise that most service providers had long cut off their relationships with such funders because they take long to honour claims. So the relationship that is currently there between doctors and medical aid societies is really beyond ZiMA and AHFoZ, but more of a mutual one.
“ZiMA and AHFoZ lost the plot when they failed to agree on a common tariff. You will see that there was a time when there was a ZiMA tariff, which was normally on the higher side and an AHFoZ tariff, which was on the lower side. This gave birth to co-payments and or shortfalls to bridge the gap between the two tariffs. “Now considering the economic environment, it no longer require the intervention of a third party. The doctor negotiates with the funder directly and they have their agreement,” he said.
Premier Service Medical Aid Society spokesperson Mavis Gumbo, said PSMAS members were not affected by the doctors’ decision because the society had arrangements with particular doctors. “Most doctors are no longer accepting PSMAS cards but we have special arrangements with particular doctors where our members can be treated and those doctors have not communicated to us that they will no longer treat our members.
“In addition, PSMAS through its investment arm PSMI has its own facilities where members can also be treated,” said Gumbo. Some Herald Online readers who also contributed to this debate, said ZiMA or AHFoZ were just associations from which their members were free to take heed of their calls or ignore them.
“These associations must simply close because they are not adding any value to this transaction. Let societies and doctors engage direct and work in any way possible and beneficial to the member who in this case is being victimised for being nice to these useless associations,” said one reader who signed off as a critical observer.
On Tuesday, the ZiMA leadership reaffirmed its position that they would stop accepting patients from medical socities with effect from 1 July 2016 and encouraged its membership to install point of sale machines to enable patients without hard cash to swipe.
The leadership also said those without money would be referred accordingly to public health institutions. ZiMA claimed that majority of medical aid societies were either not paying claims on time or were paying below the gazetted tarriff resulting in them failing to honour their tax obligations.
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