Home » Health Services » Medical Aid Societies, Doctors in Fresh ‘Talks’

Government has instituted fresh negotiations between medical aid societies and healthcare service providers following representations by the former that current tariffs were unsustainable, Health and Child Care secretary Dr Gerald Gwinji has said.

Dr Gwinji said the fresh talks where necessitated by the fact that medical aid societies indicated in their presentations that they were destined for collapse should service providers maintain current medical tariffs.

This scenario has seen the medical aid societies resisting the new tariffs and reimbursing service providers at an old rate, which is less than the gazetted tariff.

“Because of the stand-off between the service providers and medical aid societies, Government has met with all parties to try and resolve the stalemate and come up with an agreement which ensures viability for both parties,” said Dr Gwinji.

“Therefore current negotiations are underway to resolve the matters with the involvement of all parties concerned,” he said. Dr Gwinji, however, said while negotiations were taking place, gazetted tariffs remain legal. Gazetted tariff for consultation fees of general practitioners is $35 but most insurers were reimbursing doctors at an old rate of $20.

“In the interim, the gazetted fees are legal status,” he said.

According to the laws governing operations of medical aid societies, they are compelled to come up with a common tariff in liaison with service providers.

A common tariff entails doctors charging the same fee as will be reimbursed by a medical aid to ensure that the patient does not incur extra costs in shortfalls and or co-payments.

However, since 2008 medical aid societies and service providers were failing to agree on a tariff resulting in Government’s intervention last year.

Government’s intervention saw an increase of consultation fees for general practitioners to the current US$35 — a fee described by the societies as unsustainable hence the resistance.

Dr Gwinji said during the licensing procedure, Government sought to understand the reasons behind the resistance and the societies cited viability reasons.

“The Government has therefore facilitated a negotiation platform between insurers and service providers so as to ensure continued engagement,” he said.

He said once that is resolved, the matter of dealing with defaulting medical aid societies remains that which is stipulated by the law. He said to date 30 out of 32 societies which applied for renewal had been licensed.

Dr Gwinji said Government will continue negotiating with the service providers from the private sector to accept all registered medical aid cards as is the law.

The Zimbabwe Medical Association President Dr Agnes Mahomva said service providers remain committed to dialogue with a view to end the impasse.

Dr Mahomva said their membership was owed millions of dollars by various medical aid societies.

“As an association, we have notified the ministry of Health on what has been going on and have urged it to intervene. We are also approaching the Competition and Tariffs Commission to intervene, and lastly a few of our members have approached the courts to try and get a redress,” she said.

Dr Mahomva said only Premier Service Medical Aid Society and a few others were recognising the new tariffs.

She, however, said although PSMAS was recognising the new tariffs, it was struggling to service claims.

She said societies which were making consistent payments where paying well below the gazetted tariffs.

No immediate comment could be obtained from AHFoZ.

Source : The Herald