Hon. Speaker Sir, of late you have heard, largely through the media, of challenges in the working relationships between medical aid societies and representatives of individuals or by the Association of Health Care Funders of Zimbabwe called (AHFoZ) and providers of health care services particularly doctors as represented by the Zimbabwe Medical Association (ZiMA). The challenges as seen from the providers, that means the doctors and others, arise mainly from the following areas.
- There have been disagreements over tariffs for various areas of service provision.
- Payment by insurance to providers based on the insurers preferred tariff rate.
- Delays in meeting payment for services rendered.
- Referral of clients by insurers to preferred networks of providers in their clinical and laboratory facilities.
- Conflict of interests by insurers by way of building, owning and running medical and dental clinics, hospitals, pharmacies, laboratories, radiological centres, rehabilitation units, optician clinics and other related health centres.
- There has been disregard of gazetted fees by the insurers.
- Unfair and crippling taxation and recovery practices by ZIMRA based on claims lodged by providers to insurers which claims are yet unpaid and outstanding at time of taxation.
I will now go to the challenges as seen from the insurers and this is their own perspective:
- There has been disagreement over tariffs for various areas of services provision.
- Charges by providers that are way beyond what the insurers can afford.
- Demands by providers from patients for cash payment upfront while the clients are holding valid insurance cards.
So, discussion on the above mentioned issues, some of which are now long standing in nature have been ongoing albeit very slowly with a resultant near stalemate situation. Last week, ZiMA announced that they will, with effect from the 1st July, 2016, stop accepting medical aid cards and charge cash all patients seen by their constituency. The trigger situation to this is the taxation and subsequent garnishing of providers’ accounts by ZIMRA for tax obligations which are deemed due based on the act of submission of a claim by a provider to an insurer regardless of whether this has been paid or not.
Providers claim and having in some instances provided a proof that their claims usually remained un-paid for periods in excess of the statutory 60 days and sometimes for periods of up to 6 months or more. Resultantly, providers felt they were being taxed for what they have not earned. Clarification with ZIMRA indicated that ZIMRA was acting within the law and the challenge was in fact between the provider and the insurer and could therefore not absolve providers of the obligations for taxation; its timing, the resultant default status and the garnishing of accounts thereof.
To get out of this technicality and its consequences, the providers then decided on resorting to cash charges as announced until such a time that their insurers where ready to meet their obligations in a timeous manner. This situation will obviously disadvantage and stress the client who is rightfully insured but has to be exposed to out of pocket expenditures. As a regulatory authority, my Ministry called for an urgent meeting to resolve the looming crisis and we had a marathon meeting of three and a half hours to prevent further deterioration of the situation. An important stakeholder, the Minister of Finance and Economic Development, Hon. Chinamasa, was present at this meeting.
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