Prohibition Of Service Provision By Medical Aid Societies Challenged

CIMAS Group Chief Executive Officer Mr Vuli Ndlovu on Thursday vented his reservations on the Medical Aid Regulatory Bill prohibiting medical aid societies into service provision.

By Kudakwashe Pembere

With medical service providers lobbying for this move, the Health and Child Care Minister Dr Obadiah Moyo has pushed for this bill to be approved by Cabinet.

Speaking at an information campaign launch at CIMAS head office, Mr Ndlovu said he is against the prohibition part.

“The next issue I want to say on the bill is the story coming out that this bill is designed to stop medical aid societies from going into service provision because of conflicting interests. They are collecting money, they are payers but they are also providing the same kind of service.

“Therefore they are competing unfairly with other services providers. We beg to differ,” he said.

He noted the current regulations as preventing them from directing members to particular facilities.

“We never said to our members, you can only receive primary health services at our clinics. You have got the choice. You go there by choice. In the current bill there is a regulation that prevents us from directing.

“That’s the only conflict I can see. We cannot set up these facilities and say you can only go to our facilities. Does the market want that because sometimes we are responding to what the market wants? Do people actually want to be told you go to that dentist? That does not make business sense. So to us that aspect of conflict of interest does not make sense at all,” he said.

As the private sector is meant to complement the public sector, Mr Ndlovu said they have services usually not found by medical service providers.

“Not to mention that some of the facilities have been a safety valve to our members because at some point they could buy medicines in a pharmacy with US dollars but they can get it at our pharmacies. The same with laboratory services. You could not get those things at other facilities but can get them in ours.

“Dialysis. We had a situation in the public sector. Dialysis is so finicky. If you are told to go three times, you have to do that. If you go there, there dialysers are not there. You are in trouble. You could actually die. Realising that gap, we went into that business to make sure that people have got a reliable service delivery. Those two things are the things I feel we should think about to say do we really want to stop this because we believe that there is a conflict of interest,” he said.

He recommended that government rather enhance the current law forbidding members to be directed to be served at the medical aid society facilities.

“Don’t form a scheme to say you will only go to my facility only. But even when you do it, given the low barriers of entry, someone else is going to pop up next door and offer more variety. This thing should have checks and balances. So I think we need to be careful about these things, understand them and the implications,” he said.

He said this could have a detrimental effect on civil servants under PSMAS preferring getting treatment at its PSMI facilities.

“Not to mention the biggest medical aid in the country which looks after public servants. It has got huge facilities. Can you imagine a situation where those people in that medical aid who could not access services everywhere but could only do that in that network, what would they have done,” Mr Ndlovu said.

Mr Ndlovu also said the bill should foster transparency and ensure self-regulation within the medical aid industry.

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