By Mary Taruvinga
ONE of the country’s leading health insurance companies, First Mutual Health, has announced that members paying premiums in local currency are now unable to seek treatment at one of Zimbabwe’s top private health facilities, Avenues Clinic in Harare.
This was necessitated by the worsening economic crisis in the country.
The First Mutual Holdings subsidiary, however, issued a circular on Friday, noting that the denial of service does not affect members of US dollar plans.
“First Mutual Health wishes to inform members that we are in the process of renegotiating our service contract with Avenues Clinic to meet the challenges posed by the current economic environment,” reads the circular seen by Newzimbabwe.com.
“While these negotiations are ongoing, our service agreement with the Avenues Clinic has been temporarily suspended for members paying ZWL dues, and the hospital will not be providing services to our ZWL members at this time,” said the Acting Chief Executive of First Mutual Health, Tinashe Chingonzo.
However, the development has been criticized by health advocacy groups, who believe there is a lot of profiteering in the medical aid business by a few powerful providers.
Community Health Working Group (CWGH) director Itai Rusike said there was a need to regulate medical aid societies.
“When a country does not have a strong public health system, when a country depends on external partners to fund critical areas, and when a country depends on the private sector and missionary institutions to deliver primary level services and higher – so these are the results we are seeing!Perhaps all of this points to the need for a well-defined and well-designed national health insurance.
Rusike lamented the Health Ministry’s limited ability to regulate medical aid companies, hoping the new bill to create a regulatory authority will address this issue.
“The segregation of duties is very weak, for example two of the largest medical aid companies in the country are both fund managers and healthcare providers, which prevents them from focusing on their core business of setting up pooling resources and purchasing services on behalf of their clients,” he said.
“While the idea was to minimize care, this has since been abused. Smaller medical aid providers have lost business as a result, like the small trickle of patients who come to them, who are mostly not insured or underinsured and must pay exorbitant fees to compensate for the small number.
Rusike said health care is not like an ordinary need, where one can make a choice.
“Illness always comes unexpectedly and when sick people don’t have the freedom or luxury to make choices – what they want is care and nothing else – this desperation is then put to good use by healthcare providers.”
According to Rusike, there are now too many pools which have been encouraged by the Competition and Tariff Commission to increase competition in the industry to trigger better quality and lower prices.
However, Medical Aids, according to Rusike, appears to operate like a cartel.
He said the country needs a commission to examine the entire value chain of medical services on what informs their prices and interventions.
Rusike also recommended that the country have a well-defined and costed set of minimum benefits.