It seems there is chaos in the medical fraternity as doctors and other medical service providers are owed in excess of US$220 million, according to figures availed to us by the Zimbabwe Medical Association (ZIMA) with the bulk of this figure by guess who? I am sure its a no-brainer for the average Joe. Public Service Medical Aid Society (PSMAS) carries 82% of the debt which is US$180 million. This is no surprise as the former CEO Cuthbert Dube aka Cashbert was earning US$500,000 per month. It is also not surprising that the country’s biggest medical aid company, Cimas had clashes with National Physicians Association of Zimbabwe (NAPAZ), the Retail Pharmacists Association of Zimbabwe (RPA) and the Hospital Doctors Association of Zimbabwe (HDAZ) over its reluctance to honour some of the claims.
Cimas v. Corporate 24
Cimas most brutal fight however has been with Corporate 24 over hospital services offered to its subscribers. This has seen Corporate 24 engage debt collectors to recover more than US$500,000 in unpaid claims from medical aid subscribers, this sets a dangerous precedence within the medical insurance sector. In May last year the government via the health ministry threatened to cancel Cimas operating licence if it failed to honour outstanding claims from the hospital group. Cimas however got reprieve from the High Court which barred government from doing so pending finalisation and closure of the dispute. The dispute between Corporate 24 and Cimas is premised on fraud allegations levelled against the former by the latter. Cimas engaged Grant Thornton of South Africa to conduct a forensic audit on the authenticity of claims raised by Corporate 24, it is believed a draft report has been compiled and a final report will soon be released.
Medical Aid Regulatory Board
It is generally accepted within the medical services market, that government is not a neutral and independent arbiter. Its baby, PSMAS has worse of infractions than all the medical aid societies combined. Government is engaged with the process of establishing a regulatory board that will superintend medical aid societies and ease the tension between service providers and healthcare funders, as presently the ministry oversees both parties and arbitrates disputes. The Medical Aid Regulatory Board could be appointed this year if parliament passes the enabling law as recommended by the health ministry. The sad reality of these disputes is that the overall loser is the medical aid subscriber. This impasse between service providers and medical aid societies needs to be rectified as a matter of urgency as lives may be lost in the process.
Need for greater transparency
We hope to see the new Medical Aid Regulatory Board bring a culture of transparency by compelling all medical aid companies to publish their financial results, because at the end of the day they are managing public funds. Similar to the short term and long term insurance and banking sectors; they must also make their financial performance public so that the public makes informed decisions when choosing the best medical aid society for their needs. That way those swimming naked can easily be identified and the authorities can take appropriate action to save medical aid subscribers from losing out.