The Sunday Mail
Golden Sibanda
MEDICAL doctors have weighed in on the raging debate over regulation of medical aid societies, saying the $1,2 billion sub-sector is poorly regulated and that is resulting in policyholders being prejudiced.
Zimbabwe Medical Association secretary-general Mr Shingi Bopoto said medical aid societies, although they offer an insurance service by committing to pay for a service on demand, are not fulfilling the obligation.
This comes amid ongoing debate over who should regulate medical aid societies, currently under the purview of the Ministry of Health and Child Care, through provisions of the Medical Services Act.
Mr Bopoto said the Ministry of Health and Child Care itself was on record saying a significant number of healthcare funders were not compliant to laws and regulations put in place by Government.
He made the remarks in a discussion at Zimpapers’ Capital FM this week. The Ministry of Health and Child Care told The Sunday Mail Business that the country’s insurance regulator has no capacity and credibility to regulate medical insurers given their critical importance in funding health services.
Failure to meet their financial obligations in paying claims due to perceived weak regulation and limited or non-existent expertise in fund management prompted the Insurance and Pensions Commission to suggest that they have them under its watch, since the Insurance Act already allows them regulate mutual insurers such as medical aid.
The Insurance Council of Zimbabwe also contends that IPEC is better suited to regulate activities of medical aid societies, given the technical capacity it possesses on specialist expertise needed in managing insurance funds.
Despite implications of the alleged irregular conduct of both registered and unregulated healthcare providers, prejudicial to subscribers, no action has been taken by the sector’s regulator (Ministry of Health) to rein them in.
“We are on record as a professional association as saying the current regulatory framework is significantly weak and poorly enforced. As a result, you get members of the public being prejudiced. They pay subscriptions monthly but when it comes to that moment when they need service at an emergency room, they are told that they have no benefits.
“There is also a proliferation of a grey kind of health insurance products that are not regulated. You have someone collecting premiums for hospital cash back plans, you have a clothing retailer selling a hospital cash back plan and you have a telephone company doing the same and these are health insurance products. Who protects the subscribers?” he said.
Mr Bopoto said medical aid societies should be properly regulated in the same way that other service providers in the health care value chain are being regulated. Laboratories, physiotherapists, pharmacists and medical doctors are regulated by an 18-member council.
However, the Association of Health Care Funders said failure to meet obligations in paying claims is being caused by employers’ failure to remit subscriptions from policyholders to the medical aid societies on time. AHFoZ chief executive Mrs Shylet Sanyanga said they would welcome any regulator for medical aid societies.
“It has got a lot to do with the economy. Remember the funds that medical aid societies use to pay claims come from employers. We have actually been trying to bring the employers on board so that we have a seamless set-up whereby employers commit to remit subscriptions on time. That is the major reason causing medical aid societies to fail to pay claims on time, they do not have any other source of income except those contributions,” Mrs Sanyanga said.
“Technically, medical aid is insurance, but our understanding as people on the ground is that medical aid and insurance are not exactly the same.
“A typical insurance service provider has got a financial agenda and medical aid has a social agenda, the two are not the same. Whoever is going to regulate has to be aware of those differences, they are very important.
“We cannot have a one-size-fits all set of regulations for insurance and medical aid. lt would be a disaster in terms of health outcomes because if the regulator is going to be focusing more on financial performance, there is a high risk of them neglecting the health side of things, which is what medical aid societies are concerned with,” she explained.
But IPEC spokesperson Mr Lloyd Gumbo said that IPEC monitored the activities of insurers, mutual insurance societies, insurance brokers, pension and provident funds to ensure that they maintain set standards. It also ensures compliance with provisions of the Insurance Act and the Pension as well as the Provident Funds Act.
“From the above legal provisions, it is clear that IPEC is mandated to regulate mutual societies such as medical aid societies, which by their nature carry out medical insurance business,” he told an AHFoZ conference recently.
“Like any other insurance business, the medical aid societies are selling promises,” he said.
ICZ chairman Mr Mussa Bako said IPEC is better placed to regulate the insurance side of medical aid societies.
“From where we sit, it is a question of making sure that you have got a fund enough to cater for certain claims as they occur and therefore there are solvency issues to talk about. The fund must be able to meet all its obligations from the promise given(medical insurance).
“The Ministry of Health can still get involved on the suppliers’ side – looking at doctors, pharmacies and the drugs they supply,” he said.
