By Mary Taruvinga
ONE of the country’s leading health insurance companies, First Mutual Health, has announced that members paying premiums in local currency now cannot get treatment from one of the top private health facilities in Zimbabwe, Avenues Clinic in Harare.
This has been necessitated by the worsening economic crisis in the country.
The First Mutual Holdings subsidiary issued a circular on Friday, however, noting that the denial of service does not affect members on US dollar plans.
“First Mutual Health wishes to advise members that we are in the process of re-negotiating our service contract with the Avenues Clinic to address challenges brought about by the current economic environment,” reads the circular seen by Newzimbabwe.com.
“While these negotiations are underway, our service arrangement with the Avenues Clinic has temporarily been suspended for members paying ZWL contributions, and the hospital will not be providing services to our ZWL members for the time being,” said First Mutual Health acting managing director, Tinashe Chingonzo.
However, the development has been criticised by health advocacy groups, who feel there is quite a lot of profiteering going on in the medical aid sector by a few powerful providers.
Community Working Group on Health (CWGH) director, Itai Rusike said there is a need for regulation of Medical Aid Societies.
“When a country does not have a strong public health system, when a country depends on external partners for funding critical areas and when a country depends on the private sector and mission institutions to offer both primary and higher level services – then these are the results that we see! Maybe what this is all pointing to is the need for a well defined and well crafted National Health Insurance.
Rusike bemoaned limited capacity in the health ministry to regulate Medical Aid Societies, hoping that the new Bill meant to create a Regulatory Authority will address this issue.
“Separation of functions is very weak, for example, two of the biggest Medical Aid companies in the country are both fund managers and providers of care, making it difficult for them to focus on their core business of pooling resources and purchasing services on behalf of their clients,” he said.
“While the idea was to minimise care, that has since been abused. Small medical aid providers have lost business as a result, as the small trickle of patients that come their way, who are mostly uninsured or under-insured and are having to be charged exorbitant fees to compensate for the small numbers.”
Rusike said health care is not like an ordinary need, where one can make a choice.
“Sickness always comes unexpectedly and when sick, people have no freedom or luxury to make choices – what they want is care and nothing else – this desperation is then taken advantage of by providers of care.”
According to Rusike, now there are too many pools which were encouraged by the Competition and Tariff Commission to increase competition in the sector in order to trigger increased quality and lower prices.
However, Medical Aids, according to Rusike, seem to be operating as a cartel.
He said the country needs a commission to look at the entire medical services value chain on what is informing their prices and interventions.
Rusike also recommended that the country should have a well defined and costed minimum benefit package.