Published: 12 September 2017

The proposed annual registration of medical aid service providers is a threat to continuity of business and confidence as this is likely to create uncertainty and promotes looting by members, Association of Health Funders of Zimbabwe chief executive officer Shylet Sanyanga has said.

Addressing delegates recently at the annual AHFoZ stakeholders conference in Victoria Falls, Mrs Sanyanga said the proposed annual licensing requirement in the Medical Aid Societies Bill should be reviewed.

"Uncertainty created by annual licensing inhibits business continuity and investment by medical aid societies. Funders approach may be restricted to short-term goals both in financial and health terms.

"Funders may focus on acute care rather than chronic care in their benefit design.

"Because of uncertainty, members may decide they would be better off using up as much of the benefits as they can before the end of year," she said.

She cited the example of South Africa where medical aid schemes do not renew licences annually but, instead, pay levies to the regulator.

Mrs Sanyanga said the Bill should create a conducive operating environment.

"There is need to level the playing field so that local and international entrepreneurs are encouraged to invest, in line with ZimAsset. The final draft should eliminate retrogressive provisions," she said.

Mrs Sanyanga said the Bill should explore constructive ways of building confidence in the industry and provide mechanisms to protect medical aid societies from premature licence cancellation or de-registration.

"There is need to avoid criminalising all compliance issues but have constructive remedies.

"The regulatory authority should oversee and not superintend or mediate on tariff disputes.

"It should provide a guideline for funders and providers to negotiate for competitive prices within the price reference range for competition in pricing and to encourage better service delivery.

"The regulatory authority should also allow establishment and operation of agreed service level agreements (SLAs) for B2B arrangements," she added.

In the event of conflict between any parties, Mrs Sanyanga, said the regulatory authority should provide a clear conflict resolution procedure that should be followed.

"In instances where an issue is referred for arbitration, there should be fair adjudication of complaints. The regulatory authority should also offer a solution to the anomaly that is created by the failure of employers to remit contributions to medical aid societies by their due date," she added.

Mrs Sanyanga pointed out that under the proposed Bill, the 25 percent required reserves level is unnecessarily high and ties up funds that could be better spent on healthcare.

"This issue should be discussed and probably subjected to some actuarial research.

"Robust supervisory structures should be put in place to ensure that all stakeholders are protected and that the authority can identify signs of distress at an early stage," she said.

She bemoaned the inclusion of doctors on the Regulatory Board saying this introduces conflict of interest.

She added that the Bill should provide for a system of recall of medical aid cards in circumstances where the insured has defaulted.

The Medical Aid Societies Bill is expected to address multiple challenges in the health insurance sector.

Once passed into law is also expected to see the establishment of a medical aid regulatory board that would oversee the operations of medical aid societies in the country.
- chronicle

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