Saving health sector from greed and abuse

In time, some smaller MAS also set up their own facilities.

The relationship between MAS and medical services providers deteriorated as both fought for the same dwindling cake.

On the other hand, Zimbabwe’s economy was fast shrinking as the country descended into a hyperinflation whirlwind that eventually stopped with dollarisation in 2009. Employers left workers to fend for their own medical requirements. Government stood by and watched.

Former ZiMA president Chimedza was appointed the deputy minister of health in 2013, superintending over the medical aid societies (he was later to be among the seven ministers dismissed in December 2014 for “below-standard conduct and performance”). Under his watch, government gazetted new tariffs that were higher than the schedules provided by both AHFoZ and ZiMA.

It must be noted that Chimedza (and his replacement, Aldrin Musiiwa), the Health Minister David Parirenyatwa and Secretary Brigadier General Gerald Gwinji, are all practising professionals, running private surgeries. This compromises their ability to manage the confusion in the health sector.

The gazetted tariffs instructed health insurers to pay whatever health providers charges that land on their desks. This had the effect of neutralising the schemes designed by the insurers to cater for different classes of subscribers. The tariff regime also ordered the health insurers to pay within 30 days or risk losing licences, which were being issued annually.

Health insurers felt this move contributed to the rise in fraudulent claims. For example, in May last year, Cimas Medical Aid Society suspended its online drugs claim facility after it lost $1.2 million in fraudulent claims.

In the same year, First Mutual Life Holdings’ health insurance arm received over $1.5 million in fraudulent claims in the first four months.

But government went on to enforce the new law and started issuing six-month licences in lieu of payments. The health insurers had to provide evidence of payments or an aged analysis before the licence could be renewed. This is despite the ministry getting audited accounts for all health insurers.

The move has left health insurers unable to cope as they now had to deal with lower membership, lower premiums, coupled with high default rate against higher tariffs and bulging claims.

This explains the spat between Corporate 24, a health insurer with its own facilities, PSMAS and CIMAS.

Doctors are not charged tax on the service they provide, but are required to submit Pay As You Earn on salaries they get from their practice and for their employees. The surgeries, as registered private business enterprises, are also required to pay presumptive tax or corporate tax.  Most doctors have not been doing this and, naturally, Zimra has come knocking on their doors. The doctors have to make tax submissions on their personal earnings.

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