Medical aid claims: Ball in minister’s court

05 Jun, 2016 - 00:06 0 Views
Medical aid claims: Ball in minister’s court

The Sunday Mail

Asking patients to pay cash upfront (from July 1, 2016) will not be easy on the part of doctors for the simple reason that we are sworn to saving lives and caring for people.
Medical aid societies are the ones benefiting, they collect money from members of the public and don’t pay doctors.
In early 2015, we informed the regulator of medical aid societies – Health and Child Care Minister Dr David Parirenyatwa – that healthcare funders were not paying us as stipulated by law.
Several regulations and Statutory Instruments guide them on the amount they should pay and the payment timeframe.
Dr Parirenyatwa subsequently made a pronouncement that medical aid societies that would continue to breach the law would lose their operating licences. However, for one reason or another, that was never followed through. We then took our issue to the Parliamentary Portfolio Committee on Health, highlighting that regulations were not being followed and enforced.
Furthermore, we advised the Competition and Tariffs Commission that medical aid societies were not paying us and yet they were opening clinics and hospitals in direct competition with the people they were not paying. The Zimbabwe Medical Association met with the Association of Healthcare Funders of Zimbabwe on several occasions to resolve the impasse (but without success).
It is hoped the regulator will enforce regulations. Without such enforcement, we don’t see medical aid societies sticking to their mandate.
The law says no doctor shall turn away a holder of a valid medical aid card. The question is: is that card valid when the so-called medical aid isn’t paying claims? Laws (governing medical funding) should not be viewed in isolation. The Medical Services Act explains how health insurers are supposed to behave with people’s money and they are not doing that.
In the end, the patient is the one being disadvantaged. And the doctor who would have attended that patient is also disadvantaged as he or she has to pay tax on all claims submitted to the medical aid society. The whole medical industry is owed US$220 million, and this mainly covers the last three years.
Some private hospitals tell us other claims go four to five years back.
Those paying within the stipulated 60 days are only paying about 60 percent of stipulated tariffs, depending on the doctor’s specialty.
Zima is grateful to the Zimbabwe Revenue Authority because it is not doing anything wrong, but only applying the country’s tax laws.
Zimra has allowed some of our members to make payment plans, and we constantly advise them on the difficulties our members face.
Medical aid subscribers are the owners of medical aid societies, even the board of directors is appointed by subscribers.
So, perhaps we should be asking subscribers what they will do about these employees who are not using their money where they are supposed to.
We, however, repeat that Zima has reported this issue to the regulator of medical aid societies, and we hope regulations will be enforced.
We hear the ministry has given medical aid societies up to June 30, 2016 to comply with regulations or face censure. It is our sincere hope that the regulator will take action this time around for the sake of the patients.
Like I mentioned earlier, it is not easy for us to demand cash from medical aid card holders. Nevertheless, we have put in place mechanisms to ensure no life is lost unnecessarily.
Some of these measures cover life-threatening illnesses, our doctors will continue to attend to patients without asking for cash up front under such circumstances. But we will have no choice in cases such as reviews. The patient and the doctor are rocking in the same boat because they are at the losing end while medical aid societies are benefiting.
Once again, we appeal to the Health and Child Care Ministry to enforce regulations.
Our appeal also goes to medical aid societies to see reason and respect the law.
Subscribers can only be protected if everyone plays by the rules.
And we hope the powers-that-be will ensure anyone who wants to remain in the industry plays by the rules. As doctors, we feel we have tried everything – approaching the regulator, Parliament and other statutory bodies.
The situation on the ground seems not to have changed yet the doctors and other healthcare providers still have to face the taxpayer over money they haven’t received or, in some instances, may never receive.
The matter should be resolved as patients might end up with no one to provide healthcare because Zimra would have shut us down.
People must play by the rules for the sake of the public. If someone doesn’t respect the rules, you are putting the whole healthcare system at risk.
We understand Parirenyatwa Group of Hospitals is owed US$5 million. Imagine what a hospital can do with US$5 million!

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