THERE was a general decline in contributions to medical aid companies as well as delays in processing claims during the COVID-19 induced lockdown period amidst indications that most players struggled to process claims as they still rely on obsolete manual systems.
By Michael Gwarisa
Speaking during a virtual dialogue, Association of Health Care Funders (AHFoZ) Chief Executive Officer Ms Shylet Sanyanga said Medical Aid players have to think outside the box and prepare for future emergencies and also ensure they continue offering services even in the presence of global a pandemic such as COVID-19.
What we recommend is that the Medical Aid Industry and the healthcare sector should actually embrace Telemedicine. At the moment, we don’t have many funders who are on this dial a doctor facility. Most of them are having to make do with home care services. Otherwise, if we all embrace Telemdecine, it will go a long way in ensuring that there are no gaps in healthcare service delivery.
“In terms of collections of contributions by medical aid societies, there was a slow down because some of these activities require human intervention and, in some instances, some offices were not fully operational so there was a challenge of delayed submission of contributions to the medical aid societies. There was also a problem in processing claims because some processes require human intervention during the processing of claims as well as the payment to healthcare service providers. On the other hand, there was a delay by service providers who are still using manual systems despite the fact that we had introduced some Information Technology (IT) platforms for them to submit electronically. The bulk of them are still using manual claims,” said Ms Sanyanga.
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. She also added that Medical Aid players should strengthen wellness programs so as to monitor those on chronic conditions since they are at the highest of risk in the times of health emergencies.
The COVID-19 according to Ms Sanyanga also pushed up respiratory related claims since the first case of COVID-19 was diagnosed here in Zimbabwe. There was been an increase of respiratory related claims from 16% to about 28%.
Meanwhile, PSMAS Medical Aid Acting General Manager, Dr Nixjoen Mapesa said there was need to come up with sustainable and long-lasting solutions to the business of offering healthcare and players should plan with emergencies in mind.
“The fact that the pandemic has changed the way we operate cannot be overemphasized. This was exacerbated by already existing challenges the sector had been facing prior to the outbreak. The COVID-19 pandemic is poised to be a defining moment for Zimbabwe’s healthcare industry. Even as organizations across the country continue to grapple with the immediate impact of the outbreak, leaders are also beginning to plan for the future with the understanding that the pandemic is reshaping and restructuring the industry in ways that are likely to be permanent.
“While all can agree that the post COVID-19 landscape is likely to look notably different from the pre-COVID-19 reality, there is considerable debate about the degree and nature of change the industry will experience. Debate is currently ongoing around how COVID-19 will impact among other things demand of healthcare services. Talk is around the health statuses of individuals and members and how Telehealth is going to reshape the healthcare industry, how they approach behavioral health services is going to be redefined, how services to senior care and geriatric management is going to be affecting demand on care,” said Dr Mapesa.