Medical aid schemes claim they incurred $400m costs in 2014

via Medical aid schemes claim they incurred $400m costs in 2014 – NewsDay Zimbabwe July 1, 2015

THE Association of Healthcare Funders of Zimbabwe (AHFoZ) yesterday claimed in Parliament that in 2014, they incurred claims costs of $400 million which was far much more than the country’s $340 million total health budget.

BY VENERANDA LANGA

The association’s leaders told members of the Parliamentary Portfolio Committee on Health and Child Care that their industry, which encompassed medical aid societies, was plagued by falling membership numbers, high claims costs, late remittance of contributions and high default rates.

“In more recent times, we have witnessed errant behaviour by some service providers (doctors) in respect of fraudulent claims which ultimately erode member funds and increase claims costs,” AHFoZ chairperson Cecilia Nyamutswa said.

“The global figure of lives covered has not been growing as the number of people who are formally employed has not been growing, and medical aid figures have decreased by 31% from 600 000 in 2007 to 400 000 at the end of 2014,” she said.

But the MPs questioned AHFoZ over the manner subscribers to medical aid schemes were treated, pointing out that people’s monies were being invested in building of more clinics and health institutions owned by medical aid institutions yet patients’ medical and drug costs often incurred shortfalls.

Binga North MP Prince Dubeko Sibanda said AHFoZ should explain how they calculated shortfalls as well as the “ridiculously” high salaries of executives of medical aid societies at a time when they complained that patients’ claims were milking them of funds.

Premier Services Medical Aid Society managing director Henry Mandishora said in relation to their medical society, and following revelations of mega salaries, an interim management team had been set up to restructure managers’ salaries and contracts.

CIMAS operations manager Vulindlela Ndlovu said their members had approved and were benefiting from most investments made by the society.

Gutu South MP Paul Chimedza demanded that AHFoZ should give to Parliament statistics of the doctors whom they claimed submitted fraudulent claims to them.

Chimedza said it did not make sense for AHFoZ to claim 95% of their income was going towards payment of medical claims when nowadays most of them were seen investing in their own private clinics.

AHFoZ denied allegations that some medical doctors were discriminatory against certain patients and medical aid schemes.

Committee chair Ruth Labode ordered medical aid societies to consider providing medical schemes for the aged as well as incentivising medical aid subscribers who hardly seek medical attention.