Medical aid bosses, doctors draw battle lines

The Association of Healthcare Funders of Zimbabwe (Ahfoz) has directed members to disregard gazetted consultation fees and pay tariffs it has prescribed instead. Government, however, immediately vowed not to renew licences of defiant medical aid societies in 2015.

Doctors are also threatening legal action to compel all Ahfoz members to abide by the stipulated fees.

The gazetted tariffs are US$35 and US$20 (general practitioners), and US$120 for specialist doctors.

Ahfoz wrote all its 23 members on October 13, informing them to pay US$25 (initial consultation) and US$18 (review visits). Its circular reads, in part: “Further attempts to negotiate with providers have not yielded any results. At the executive committee meeting held on Thursday, October 9 2014, the executive committee resolved that despite the rejection by doctors of the offer to review the (general practitioner) GP initial consultation to US$25 and the subsequent to US$18, funders should go ahead and implement this review with effect from October 1, 2014, so as to demonstrate that the offer was made in good faith.”

In May, Government published new fees as a compromise following a deadlock between Ahfoz and medical practitioners.

The Zimbabwe Medical Association (Zima) wanted higher tariffs and cited rising operational costs. On the other hand, Ahfoz advocated marginal fee increases to ensure affordable healthcare for hard-pressed workers.

In July, the two parties met to review their positions, but failed to reach consensus.

Ahfoz offered US$25 and US$18 against the doctors’ US$35 and US$30 demand.

Some medical practitioners are turning away members of defiant medical aid societies, while others are demanding shortfall payment from patients. Societies failing to settle medical claims will not be licensed in 2015, according to the Ministry of Health and Child Care. Zima secretary-general Dr Shingi Bopoto said: “To our knowledge, about 21 medical aid societies who are members of Ahfoz have not complied. However, Zima acknowledged the efforts of a few medical aid societies which are complying with the law.

“Zima lobbied the Ministry of Health and Child Care to intervene on the issue of medical tariffs after the persistent refusal by medical aid societies to award a revision on what they reimburse to service providers.”

He continued: “As most medical aid societies have disregarded these regulations, Zima is exploring all options, including legal, to deal with those who are breaking the law.

“Unfortunately, an agreed tariff failed over the past four years on account of medical aid societies refusing to award any increment to service providers even though they had increased their subscriptions several times in the same period.”

Health and Child Care Deputy Minister Dr Paul Chimedza said authorities will act sternly against defiant health funders.

“We aren’t back-tracking on the issue of gazetted medical tariffs. Medical aid societies that don’t adhere to the tariffs will not see their licences renewed.

“. . . Cimas, for instance, are saying they are not viable whilst they are busy buying hospitals and surgeries using pubic funds.

“They are complaining that the gazetted tariffs are too high. So, where does the inviability come from?”

1,537 total views, no views today