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There is need for a radical rethink about medical insurance in Zimbabwe and subscribers to medical aid societies need to be treated as rational adults rather than as dimwits who have to be spoon-fed with benefits treated as entitlements.

The problem is who is going to pay, and far more critically, how much will they pay, for services given by health professionals, laboratories, hospitals and pharmacies.

Service providers should be properly rewarded. We need to retain top-class professionals within Zimbabwe. At the centre of the present dispute between the societies and service providers is the fee that a general practitioner can charge, and we have absolutely no problem with the $35 fee that has been set by the Ministry of Health and Child Care.

That fee has to cover the costs of support staff, premises and equipment before giving the doctor a reasonable income and we agree with the health providers that this is a fair fee.

But we also agree that with the present subscription charges of medical aid societies this fee cannot be paid in full without making these societies unviable. The present charges of the societies were calculated on a $20 general practitioner fee and GP fees are a significant percentage of all payouts by medical aid societies.

So, granting that the new $35 fee is fair, there are just two choices: either societies increase their subscriptions, charging those who buy medical insurance more each month, or we accept that subscriptions remain the same, but patients pay $15 in cash every time they see a doctor, with the other $20 paid by the society.

Some people may want one option and some the other. Why not let them choose?

A rational person buying medical insurance may not be too worried about whether the insurance covers little bills. This is a convenience rather than a necessity. What people do need is to be covered, in full, for the far rarer but far more expensive services.

If you are smashed up in a car crash you want to know that your medical aid will cover the emergency and other medical treatment, which could well come to several thousand dollars.

If you are diagnosed with cancer you want the society to pay for the expensive but effective treatments now available. And when the Ministry is approving medical aid societies it needs to ensure that these rare, but expensive emergencies are covered.

This is the heart of insurance. We insure our homes in case they have to be rebuilt after a fire, not to replace tap washers. Home insurance is therefore cheap, since so few homes burn down each year that with a few dollars from each insured person we can have the large sum for the unlucky one.

There are those who see medical aid as something different, paying the little bills as well as the big bills. We are sure medical aid societies can work out a subscription for these people. Then there are those who are prepared to self-insure for the little bills, or at least part of the little bills, while making sure the big bills are paid by the insurer. Well, they should be able to choose such a scheme and a cheaper rate.

We think the Ministry, the societies and the service providers could easily come up with the requirements of a tier of schemes. The minimum scheme would cover in-patient hospital treatment but perhaps nothing else. Every society would have to offer a full scheme, covering everything at gazetted fees, and then could offer other schemes between the minimum and maximum and priced accordingly.

Let us treat those who have to pay, either in cash or through medical aid subscriptions, as if they are rational people able to make rational choices, ensure that they know the benefits and risks of each option and then let them choose from a bouquet of options. We can then have our cake and eat it.

Source : The Herald