Home » Health Services » Parirenyatwa Is On the Right Track [editorial]

Trying to set appropriate fees for the private medical sector is extremely difficult, since most people who use private doctors and private hospitals are on medical aid, there is a clear need for agreed tariffs so far as possible those who are insured either have no shortfall, or only modest shortfalls for which there are good reasons.

Before the Great Inflation there was a system that largely worked. Almost all private doctors and dentists and private hospitals accepted medical aid cards fees covered by insurance were set every now and again through detailed negotiations between the medical aid societies and the providers of services.

There were shortfalls. Some were deliberate, wanted by the medical aid societies to stop abuse. With 100 percent insurance there were cases where someone with a headache would see a doctor to get a prescription for free aspirin and there were many other instances where medical aid members would seek medical attention that was not rationally needed.

A small co-payment at least made people think first. This kept costs down for the rational and responsible majority.

And there were always some practitioners who charged a little more than the agreed tariff.

A set tariff does raise a number of questions. Should a doctor with 20 years experience and acknowledged as a leader in the profession be forced to charge the same as a youngster just registered? Should a private hospital with all facilities have to charge the same theatre fees as one offering basic clinic services?

And in any case should the theatre fees for a simple 30-minute operation be the same as for three hours of complex surgery?

During the period of hyperinflation a lot of things changed. Just about all doctors moved to cash. Large differences were seen in fees, with the best able to charge more.

We saw pure market forces at work in the end and market forces working in a sellers market since so many professionals went to work outside the country. With the introduction of multi-currencies things stabilised, but did not return to the old system.

Some professionals decided to come back or stay. The University of Zimbabwe continued to graduate reasonable numbers of well-educated doctors and dentists and its post-graduate programmes made inroads into the shortage of specialists. Private hospitals were able to buy new equipment and hire competent staff.

But medical aid societies retained the initial fees of the transition to full dollarisation, when everyone was badly paid.

Health and Child Care Minister David Parirenyatwa, who is a medical doctor, has made his position clear over the last year: he wants a return to the system where all private providers accept medical aid cards.

He wants the societies, in turn, to pay bills promptly. And now he wants medical aid societies to accept that higher tariffs are required and has chosen figures that are close to what most responsible doctors charge while at the same time, with other fee suggestions, he obviously wants certain specialists to look at using more auxiliary staff to filter patients, as some already do.

He gives the g impression of a man wanting the return to a fair, reasonable system that works for everyone.

There can be minor quibbles over his rulings as a referee but these can be sorted out. In any case we do not see a better referee.

As minister he wants a functioning private system to keep as many people as possible away from a swamped State system as a doctor he knows precisely how much a private practice needs to cover costs and provide a fair income for highly-qualified professionals. We urge the profession and the medical aid societies to use the minister’s figures as the starting point and if a more complex tariff system is needed then this will be worked on.

At the same time we think a modest co-payment can cut abuse, although full insurance is also desirable, especially at hospital level.

The matter is complex, but the referee is both knowledgeable and fair.

Let’s work with him on this one.

Source : The Herald