By Staff ReporterMASVINGO – A proposed amendment to Statutory Instrument 330 of 2000, which seeks to prohibit medical aid societies from owning clinics, pharmacies or hospitals, has divided opinion among health sector stakeholders, with some welcoming the move while others warn it would hurt ordinary patients.The amendment, put forward by the Ministry of Health and Child Care, aims to stop medical aid societies from venturing into healthcare service provision, ensuring they focus solely on their core business of pooling resources and purchasing services on behalf of members.Community Working Group on Health (CWGH) Executive Director Itai Rusike said the proposal was justified, arguing that medical aid societies cannot be both fund managers and care providers because it becomes difficult for them to concentrate on their core business.“They cannot be fund managers and care providers because it will be difficult for them to focus on their core business of pooling resources and purchasing services on behalf of their clients. While the idea was meant to minimize care, that has since been abused,” said Rusike.He pointed out that some providers connive, for example, doctors refusing to allow diagnostic tests to be done by any laboratory other than one they favour.Rusike also said small medical aid providers had lost business, and the trickle of patients that come their way mostly uninsured or underinsured were charged exorbitant fees to compensate for low numbers.“Health care is not an ordinary good such as bread or drinks where one can make a choice of either to consume or not. Sickness always comes unexpectedly and when sick, people have no freedom or luxury to make choices. This desperation is then taken advantage of by providers of care. Maybe what this is all pointing to is the need for a well-defined and well-crafted National Health Insurance Scheme,” he said.A local doctor who spoke on condition of anonymity agreed with Rusike, likening the current situation to a football league regulator owning its own team.“The current situation is not proper because there are no checks and balances. If you are the one providing insurance, you are saying you are covering the medical risk. You cannot be a service provider; you have to strictly be a funder. If you provide that service, who will guarantee value? Who will determine quality?” the doctor asked.The Doctor argued that insurers should not open clinics but instead focus on quality checking to ensure members receive what they deserve.“It is daylight robbery to beneficiaries. If we don’t address this, everyone will start venturing into medical aid societies, then they will want to establish hospitals and start giving substandard services, and patients will suffer,” said the Doctor.However, a medical aid holder who also refused to be named said ordinary policyholders would suffer from the change. Saying it would become more difficult to access services, forcing patients to pay cash on top of their medical aid contributions.“The reason these clinics and pharmacies were created is that ordinary aid holders were failing to get services from private medical practitioners. You would be told the medical aid was not working there, so they needed cash because medical aids were delaying payments to service providers. Some would even require unnecessary top-ups,” he said.He urged the government to address unstable pricing in the health sector than imposing a ban.“Pricing is not stable. Everyone charges what they want depending on the desperation of the patient. Issues of health are a matter of life and death, so you have no choice but to pay.“Exchange rate issues also need to be addressed. You go to a practitioner, they charge in US dollars; if you ask for the charge in local currency, the price triples even surpassing black market rates,” he said.He added that contributions were already high especially those paying in local currency saying the rates surpassed balckmarket rates by far.“I pay ZiG7,000 (close to US$300) for myself and my three children not even for the best medical aid. That is what the government should be reigning in.”Batanai HIV and Aids Service Organisation (BHASO) Director Farai P. Mahaso suggested an alternative approach than imposing a ban.“Instead of banning medical aid societies from owning healthcare facilities, adopt conflict-of-interest safeguards such as transparent pricing and independent audits, while strengthening solvency rules and member protections. This balances regulatory clarity with affordable access,” said Mahaso.The Association of Healthcare Funders of Zimbabwe (AHFoZ) has backed calls for the establishment of a medical aid society’s regulatory authority to address challenges targeted by the proposed amendment. AHFoZ chief executive Shylet Sanyanga was recently quoted in the media saying an outright ban would be a setback.“When we look at the ban or prohibition of medical aid societies from going into healthcare services, that is, banning them from owning clinics and hospitals, we believe that would be a retrogressive position. It will take away the current option that medical aid members have. If a service provider rejects their medical aid card, they have at least the option of going to their medical aid society’s units. But if those units are forced to close, patients are left at the mercy of service providers who may not be willing to accept medical aid as a form of payment,” said Sanyanga.She noted that these facilities play an important role in the health sector by providing services and easing pressure on the country’s health delivery system.“If anything, those facilities are actually contributing to offering healthcare services, not only to medical aid societies’ members, but to any other patient seeking healthcare services,” she said.AHFoZ has also called for a transition to a risk-based capital model, a supervisory framework designed to strengthen financial oversight and sustainability within the sector. The proposed amendment seeks both the prohibition on service provision and the shift to this new capital model.
