NATIONAL HEALTH INSURANCE STILL ON THE CARDS | Despite the dwindling formal sector that has traditionally been the anchor of the country’s economy, government, through the ministry on Health and Child Care, is determined to soon introduce a National Health Insurance Scheme (NHIS).
Stakeholders have, however, warned that introducing the scheme at a time when the economy is highly-informalised would be futile given the difficulties government is currently facing in taxing the informal economy whose activities are not included in the country’s gross national product and gross domestic product.
The Zimbabwe Revenue Authority has been struggling to get the fluid informal sector to pay taxes.
“Government has committed itself to introducing a National Health Insurance Scheme in order to ensure that all our people have access to affordable health services,” said Health minister, David Parirenyatwa in a speech read on his behalf by his deputy, Aldrin Musiiwa, at an Association of Healthcare Funders of Zimbabwe conference in Victoria Falls last week.
“It is our hope that such a scheme will be established soon. It is important that such a scheme should benefit not only those who are employed and so able to contribute to such a scheme but those in the informal sector and those who are unemployed. As government, our priority is to protect vulnerable members of society,” he added.
Government’s eagerness to provide universal health access comes as the healthcare sector is barely being able to keep its head above the water.
For example, of the $300 million allocated to the health sector in 2015 by the State, through Treasury, nearly 70 percent of it was gobbled up by salaries leaving 30 percent for drug, equipment purchases and other capital needs.
Past experience also shows that the ministry has hardly received full amount of what it is allocated in the National Budget.
The introduction of the NHIS also comes at a time when the health sector is experiencing a major decline in membership due to the shrinking formal sector with membership at 1,3 million in a population of around 16,5 million people.
Stakeholders in the sector have also been at loggerheads over tariffs for many past years.
“Medical aid societies say that if health service charges are higher than health funders can afford, then the health funders may either have to increase membership subscriptions or limit the benefit payable, resulting in payment shortfalls that the member has to meet.
“This is a situation we have faced for a while now, as healthcare service providers and funders have failed to agree on fees. Each side gave its strong arguments in support of their preferred fee structures.
“Healthcare funders say they cannot afford the increased charges of doctors and other service providers without increasing membership subscriptions or premiums and that they do not believe their members could afford such increases.
“Service providers would naturally like their charges to be paid in full by funders. Patients too would like funders to pay the charges in full, although they would also not want their medical aid subscriptions increased,” Parirenyatwa said.
HFoZ chief executive officer, Shylet Sanyanga expressed hope that a new tariff would soon be in place following a scientific study into the thorny tariff issue.
“The scientific study on tariffs was commenced on July 4, 2017. It is due to be completed October 4, 2017. The exercise was agreed to by AHFoZ and ZiMA (Zimbabwe Medical Association) and was given a nod by the minister of Health and Childcare. The objective was to come up with a scientifically recalibrated tariff that is relevant to the economic environment within which the healthcare ecosystem exists, as well as to restore fee relativity,” said Sanyanga.
Meanwhile, government’s plans to establish a Medical Aid Societies Act, which seeks to, among other things, provide for the establishment of a Regulatory Authority for medical aid societies to register the medical aid societies and control and coordinate their functioning in a manner that would complement national health policy and protect the interests of members of medical aid societies.
Allaying fears abound in the sector, Parirenyatwa said: “Some of you may be apprehensive about the introduction of such an authority. I would like to assure you that, while regulation does imply rules that have to be complied with and penalties for non-compliance, the proposed regulatory authority is not intended to be an oppressive overseer of medical aid societies, but rather an agent for the creation of a conducive environment for all players in the ecosystem.
“A law cannot be passed for the sole objective of punishing. We are cognisant of the fact that any drastic action taken against a medical aid society, such as suspension or deregistration, will adversely affect the patients belonging to that medical aid society.
“Our desire as a ministry is that such drastic action should not be used as the first option in resolving issues of compliance. As the old saying goes: ‘You do not burn an entire homestead because you have seen a snake therein.’ It is in our interests as government to nurture what we have, not destroy it.”
The medical aid societies paid out to service providers a collective $324 365 937 in 2016 compared to the 2016 ministry of Health budget allocation of $330 million from the National Budget, highlighting the important role they are already playing in the country’s health sector.