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ELSEWHERE on these pages, we publish a ministerial statement delivered by the Minister of Health and Child Care, Dr David Parirenyatwa, in the House of Assembly on Thursday, on the impasse between doctors and health insurers. The statement followed a three-hour meeting convened by the Government and attended by the Zimbabwe Medical Association (ZiMA), Association of Health Care Funders of Zimbabwe (AHfoZ) and the Minister of Finance and Economic Development Cde Patrick Chinamasa.

The indaba was prompted by an ultimatum issued by doctors that they would, beginning July 1, demand cash upfront from clients due to disagreements between them and medical aid societies over a number of contentious issues. The doctors are also up in arms against the Zimbabwe Revenue Authority for garnishing their accounts even though some of their claims would not have been paid by health insurers.

The major disagreement doctors have with medical aid societies is over tariffs for various areas of service provision. Other areas of dispute include payment by insurers to providers based on the insurer’s preferred tariff rate, delays in meeting payments for services rendered, referral of clients by insurers to preferred networks of providers and their own clinical and laboratory facilities, conflict of interest by insurers by way of building, owning and running medical and dental clinics, hospitals, pharmacies, laboratories, radiology centres, rehabilitation units, optician clinics and other related health centres.

They also cite the disregard of Gazetted fees by insurers, unfair and crippling taxations and recovery practices by Zimra based on claims lodged by providers to insurers which claims are as yet unpaid and outstanding at time of taxation. On their part, insurers differ with doctors over tariffs for various areas of service provision, charges by doctors that are way beyond what the insurance can afford and demands by medical practitioners from patients for cash payments upfront while the clients are holding valid cards.

In discussions held in a frank and candid atmosphere both parties appear willing to compromise to find a way forward and we commend them for putting the interests of patients ahead of their own and we hope the situation will be resolved soon. Both parties have valid arguments and we agree with ZiMA that it is unfair for insurers to delay payment for services rendered because this disadvantages doctors and leaves them vulnerable to garnishing by the tax authorities.

We also feel it is unprofessional for insurers to refer clients to their preferred network of service providers and facilities. On the contentious issue of tariffs, we feel both parties should stick to the gazetted prices so that they avoid the issue of squabbling over the correct rate. We acknowledge that health care is expensive in private practice but we feel a compromise can be reached between doctors and medical aid societies on a fair price.

We are glad that the Minister of Finance, Cde Patrick Chinamasa said he would look into how the taxation timing issue could be handled because it is unfair for doctors to be docked funds for which their claims would not have been processed. We also applaud the insurers for agreeing to scrap the preferred provider approach, and that the parties gave those in arrears, time to work towards a framework to pay for claims within the statutory 60 days. We note that the Government is promulgating a law that seeks to address stalemates that arise between doctors and medical aid insurers and we welcome the development.

In his statement to Parliament, Dr Parirenyatwa said: “My Ministry has embarked on the process of crafting a Bill for regulation of medical aid societies. Five weeks ago, the principles of this bill were accepted and passed in Cabinet and the drafting process has started. We now have a draft which will circulate to all stakeholders. We want to find out from you legislators how we can expedite the Bill so that it becomes an Act to be effective.”

The Bill, when passed into law, will among other things address issues of disagreements over tariffs, audits, conflicts of interests among insurers of building, owning and running medical facilities among other issues.

Dr Parirenyatwa said a long term solution was roping in the services of actuaries in the fixing of medical aid prices and we totally agree with him.

To resolve the issue of co-payments, medical insurers and providers must agree on new tariffs that are affordable to medical aid societies and acceptable to the service providers. This appears to be a reasonable compromise.

We sincerely hope the latest moves to resolve the impasse will yield the desired outcome. We call on all parties to be pragmatic and not let greed cloud their judgment because in the bigger scheme of things, the interests of the patient should come first. So as they report back on Monday, we hope they are flexible enough to realise that the country’s economy is going through trying times and patients cannot afford to fork out cash upfront while religiously keeping up with their medical aid contributions.