By Byron Mutingwende
Stakeholders have called for the setting up of an independent medical insurance regulator in order to close the gaps in the current system.
That emerged at the Zimbabwe Medical Association (ZiMA) Workshop held on 17 October 2017 at the Rainbow Towers Hotel in Harare.
“The proposed regulatory authority, provided for in a Draft Medical Aid Societies Bill should create a conducive environment for everyone in the health ecosystem. The authority must be independent, fair and effective so as to protect the insurer, the consumer and the provider of health services,” said Dr. Agnes Mahomva, the ZiMA President.
Dr. Tapiwanashe Bwakura, a Harare-based physician said it is important for the proposed authority to be constituted by people with the relevant knowledge, skills and experience for it to be comprehensive in its enforcement of rules and regulations.
“Take for example the current medical aid card. It does not indicate or guarantee payment for services provided, as is the case with a Visa card. That means the insurer is at liberty to choose when to pay and how much to pay. The proposed Bill doesn’t address such anomalies. The management of financial health funders, encumbrance and investment by medical aid societies leave loopholes as there is no requirement for prior approval,” Bwakura said.
Dr. Ruth Labode, the Chairperson of the Health Parliamentary Portfolio Committee said the Board members of the regulatory authority of health insurance should be recommended by the minister and approved by Parliament and must meet the forthcoming Corporate Governance Bill requirements.
Access to basic, accessible and adequate health services is a fundamental right enshrined in the Constitution of Zimbabwe whilst the provision of affordable healthcare to all Zimbabweans forms the backbone of the current Zimbabwe National Health Policy.
Munyaradzi Machinjika, the Manager of Insurance and Micro-Insurance of the Insurance and Pensions Commission (IPEC) said health insurance in Zimbabwe has malfunctioned oftentimes to the disadvantage of not only thousands of needy patients but also critical service providers such as members of Zimbabwe Medical Association(ZIMA) and other supply-side industries such as pharmaceutical manufacturers and transporters.
“We view current challenges in the medical health sector as primarily due to the current absence of a prudential and market conduct regulator such as IPEC. Prudential regulation is the regulation of financial institutions and supervision of the market conduct of these institutions following set down legal requirements,” Machinjika said.
Although the current Insurance Act is sufficient to regulate Medical Aid Societies (insurance), Section 18-28 of the Insurance Bill has again provided for the regulation of Medical Aid Societies.
Machinjika said that tithin the SADC region, a study was conducted under the auspices of the Committee of Insurance, Securities and Non-Banking Financial Authorities (CISNA). The study revealed that medical aid schemes within the SADC region are facing various challenges which are due to under regulation.
“These challenges, which mirror the current situation of Medical Aid societies in Zimbabwe, include the abuse of the funds; unfair treatment of beneficiaries; non-payment of service providers; non-existence of proper regulatory framework; medical insurance fraud; and information gaps among and between critical stakeholders such as policy owners, service providers and trustees.”
Examples of regional countries where medical Aid societies are regulated by the insurance regulator include Namibia, Botswana and Swaziland. Zambia is in the process of moving medical aid societies to the Pensions and Insurance Authority in line with the CISNA resolution. South Africa experienced tremendous challenges with Medical insurance and thus the transfer and tightening of medical insurance regulation to the Financial Services Board has recently been advanced.