‘People should invest in their health’

The Association of Healthcare Funders of Zimbabwe (AHFoZ) will convene an all-stakeholders conference this month in Victoria Falls to examine, among other things, effective medical aid coverage, at a time when many health insurance policy holders are complaining about deficiencies. Our News Editor Tendai Kamhungira (TK) spoke to AHFoZ chief executive Shylet Sanyanga (SS) to discuss the forthcoming conference and general issues impacting the sector. Below are excerpts of the interview:

TK: We understand AHFOZ is holding a conference this month, tell us more about this event?
SS: The AHFoZ annual all-stakeholders’ conference on health will run from 14 to 17 September 2022. The conferencing days being 15 and 16 September 2022. The event brings together all-stakeholders to discuss challenges in the healthcare sector. Everyone is a stakeholder when it comes to issues of health.
Those expected at the conference include, among others, all healthcare provider groups, medical aid representatives, government and private hospital representatives, senior government officials, employer organisations, human resources officers, as they deal with employee health-related challenges.
TK: What is the theme for this year’s conference and what will be its possible impact on the medical insurance sector?
SS: The conference will run under the theme: Healthcare ecosystem: Time to Redesign. The conference is a rich source of training and development for players in the healthcare sector. It has continuous professional development (CPD) points necessary for continuous development of professionals. The conference will facilitate exchange of notes with speakers from outside the country. Furthermore, resolutions from the conference provide rich source documents for strategy formulation for both government and private sector.
TK: Which issues are set to be discussed during this year’s conference?
SS: Among others, speakers will talk about effective medical aid coverage, economic outlook and its impact on the healthcare sector. Professor Patrick Lumumba will speak on the topic: Access to Healthcare in Africa, while Dr Alex Gasasira, the W.H.O country representative will present on the topic: Emerging Issues from the W.H.O Perspective.
TK: How many medical aid societies are part of your association and how big is the membership, collectively?
SS: We currently have 42 member schemes, collectively covering 1,7 million lives.
TK: What is the relationship between health care funders, health care providers and consumers?
SS: This relationship is usually strained mainly by issues of payments. Service providers expect to be paid at a certain level and on time. Payments by medical aid which fall below the provider’s fees result in the provider collecting a shortfall at the point of care. Some shortfalls become deterrents to access if the patient cannot afford the shortfall.
On the other hand, medical aid societies collect member contributions from their members on a monthly basis. The ZWL contributions have been losing value by the time of settling claims. Tariffs used for claims settlement are not adjusted in line with the parallel rate, contributions are not pegged on the parallel rate. This causes a mismatch and a shortfall for the member to settle.
TK: Why is it prudent for one to join a medical aid service provider?
SS: Medical aid is a health insurance whereby a group of people pay into a pool, in preparation for a future healthcare need. The concept is built on the principle of cross subsidisation whereby the rich pay for the poor, the well pay for the sickly, the young pay for the old. People should join medical aid early in life, ideally before the age of 65. It becomes difficult and expensive to join in old age.
The older one becomes, the more their health fails. Actuaries therefore, calculate expensive rates for those who would not have contributed earlier into the pool and will now be joining at a frail age. People should invest in their health instead of prioritising investing in burial. People should live before dying.
TK: You spoke of shortfalls, which service providers are continuously demanding from policy holders even when they are fully paid, why is such a situation prevailing?
SS: This is mainly due to the exchange rate disparity whereby the service provider fees are converted at Parallel rate whilst reimbursement tariffs are converted at the official rate.
The source of income for paying claims is member contributions, from member salaries which are not adjusted in line with the parallel rate. In addition to that; contributions should be pegged at viable levels by actuaries so that they can meet service provider expectations.
This will inevitably impact on the wage bill. Viable adjustments become necessary so that members can still afford both medical aid and meet their day-to-day bread and butter issues.
TK: What do you think needs to be done to correct this anomaly?
SS: This can self-correct if the gap between the official and parallel rates is narrowed.
TK: What is your take on the need for universal health coverage in Zimbabwe?
SS: It is important that all citizens have access to quality and affordable healthcare services. The country needs to implement its own strategies around this issue.
There is no “one size fits all” formula for universal health coverage.
Whilst some lessons can be learnt from elsewhere, the country should have its own home-grown solution on this.
newsdesk@fingaz.co