Kudakwashe Pembere
A 26-year standoff between medical aid funders and healthcare service providers is threatening to intensify following proposed amendments to Statutory Instrument 330 of 2000 that would bar medical aid societies from owning or operating health facilities.
The Health and Child Care Ministry recently convened a consultative meeting with medical aid societies and service providers to deliberate on the proposed changes to the Medical Services (Medical Aid Societies) Regulations. Central to the debate is a clause compelling medical aid societies to disinvest from healthcare facilities within 36 months of the amendment taking effect.
Medical practitioners argue the move is long overdue. Medical aid societies, however, warn it could destabilise the sector.
Speaking to HealthTimes after the meeting, Dr Johannes Marisa said the amendment could finally address the long-standing conflict between service providers and insurers.
“Yeah, we need the Amendment of the Medical Aid Societies regulations. It should be amended. For all this time there’s been acrimony between service providers and health insurers,” he said.
He argued that patients have borne the brunt of the fallout.
“And this acrimony has actually been affecting our patients negatively, because a patient who is insured is expecting to get medical care for a treatment, and at the same time that patient is rejected. Why? Because service providers are disgruntled. They become disgruntled because some of them are not receiving payment in time,” he said.
Dr Marisa said payment delays have, in some cases, exceeded the stipulated 60-day limit.
“Some medical aid societies are going beyond the stipulated 60 day time limit, while others can actually stretch to two years before the pay. And all this is emanating from the fact that some of the medical aid societies are now delving into service provision, and they become conflicted already. Therefore all the energy, the power, is diverted to their own clinics at the expense of health insurance,” he said.
He added that reform was overdue.
“So that’s where we are having problems. So it’s a very good amendment. And we need these things. It has been long overdue. Since 2000, when the Act was put in place 26 years ago, it’s now overdue. Let’s amend it so that we demarcate service provision and insurance provision,” Dr Marisa said.
However, the Association of Healthcare Funders Zimbabwe (AHFoZ) defended medical aid societies’ involvement in service provision, arguing that it supports Universal Health Coverage.
AHFoZ chief executive Mrs Shylet Sanyanga warned that forcing medical aid societies to shut down health facilities would carry social and economic consequences.
“Healthcare facilities owned by medical aid societies should not be closed because of the social and economic consequences, some of which are:
“Whilst Medical aid societies are in service provision to ensure that their members have an alternative in the event that service providers reject medical aid Cards or Charge prohibitive shortfalls, the facilities also service any other Zimbabweans. This is inline with the National Health Strategy on promoting universal access to health and are complementing government in that regard,” she said.
She described the proposed closures as a backward step.
“Some patients on lower level packages are able to access GP services by virtue of belonging to the pooling arrangements under medical aid. Therefore closing health facilities would be retrogressive.
“On the other hand, the time frame given for closure will collapse the entire industry. It should be noted that medical aid societies are in the business of health and should not be confined to just collecting money and paying claims,” she said.
CIMAS Health Group chief executive Vuli Ndlovu echoed concerns about the process, saying members of medical aid societies should be directly consulted given the potential impact of the changes.
“The effect of the proposed amendment is that medical aid societies will be barred from owning, operating or managing healthcare services such as clinics, hospitals or associated medical units,” he said.
He confirmed that societies currently operating such facilities would be required to disinvest within 36 months once the amendment becomes effective.
“Whilst consultations have begun, we have advised the Ministry that these engagements should be expanded to members directly, considering the nature of the amendments and their direct impact,” Ndlovu said.
Permanent Secretary for Health and Child Care Dr Aspect Maunganidze, represented at the meeting by Chief Director for Policy and Planning Dr Stephen Banda, said the review was necessary given changes in the health financing landscape since 2000.
“Statutory Instrument 330 of 2000 has served as the primary framework for medical aid societies for over two decades. However, the contemporary health financing landscape has undergone significant transformation,” he said.
He cited evolving healthcare delivery models, sustainability concerns within medical aid schemes, shifting consumer expectations and the need to maintain regulatory relevance as key drivers for reform.
“It is imperative to strengthen this framework to ensure it remains responsive, transparent and fit for purpose,” he said.
The draft amendments aim to improve accountability and fiduciary standards within medical aid societies, strengthen safeguards for contributors and beneficiaries, enhance financial transparency, promote fairness and long-term sustainability, and harmonise regulations with current health sector realities.
