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Darlington Musarurwa and Africa Moyo
Medical aid society Cimas and the National Physicians Association of Zimbabwe (NaPAZ), which were on a collision course a fortnight ago, have smoked the peace pipe, but the Zimbabwe Hospital Doctors Association and Retail Pharmacists’ Association of Zimbabwe (RPA) have became the latest groupings to take aim at the service provider.
Last week, The Sunday Mail Business reported that NaPAZ had advised physicians to opt for cash payments only for Cimas subscribers as the latter insisted they would not pay out any claims submitted from July 1 by doctors that fail to renew their Association of Health Funders of Zimbabwe (AHFoZ) numbers.
The NaPAZ letter dated June 30, 2015 – co-signed by the president and secretary-general of NaPAZ Dr Christopher Pasi and Dr Ngwende, respectively, and addressed to the country’s major health institutions – intimated that physicians were willing to engage Cimas.
“Please be advised that with effect from July 1, 2015, all Cimas patients seen in the rooms or admitted by physicians will be required to pay cash upfront. This unfortunate situation has been brought about by the position communicated by Cimas that they will not pay out any claims submitted from 1st July by doctors who fail to ‘renew’ their AHFoZ numbers by June 30 2015.
“The concept of ‘renewing the AFHoZ number’ is something that we strongly disagree with. Our position has been communicated to Cimas and other stakeholders . . . NaPAZ stands ready to discuss with Cimas in a fruitful and frank manner so that an amicable solution can be found,” read part of the letter.
Following publication of the article, the medical aid society sent bulk messages to its subscribers on Monday July 6, 2015 indicating that physicians were accepting Cimas cards. In fact, Cimas claims that it managed to convince the physicians to withdraw the circular by last week.
Hospital doctors complain
But just before Cimas could catch its breath, the ZHDA made a raft of allegations against Cimas and Premier Service Medical Aid Society, accusing the two of running dysfunctional schemes and “illegally” spreading their tentacles into services that are reserved for medical practitioners by law.
ZHDA national president Dr Fortune Nyamande implored Government to strictly enforce the law.
“The ZHDA notes with great concern the continued deterioration in the quality of services rendered by medical aid societies, notably PSMAS and Cimas. Currently it is now almost impossible to get urgent access to treatment and drug facilities by patients subscribing to these medical aid societies.
“The outlined two medical aid societies have since departed from their core mandate of providing health insurance and have been concentrating on infiltrating the medical profession through illegally opening clinics and health provision centres.
“The law clearly stipulates the role of medical aid societies, the illegality of advertising medical services, and the role of health care funders visa vis their recent drive to employ general practitioners and some specialists.
“The ZHDA condemns in the strongest possible terms the deliberate lack of enforcement of the law and regulations by the Ministry of Health so as to bring sanity to the conduct of Medical Aid societies. The rot being brought by medical aid societies is prejudicing hundreds of thousands of patients daily and has of late been the most persistent demoralising agent to medical practitioners.
“The Ministry of Health must be made to account for lives lost as a result of the failure to date to revitalise PSMAS and the wanton disregard for the medical profession being exhibited by CIMAS,” said Dr Ngirande.
Retail pharmacies up in arms
On Friday, the Retail Pharmacists Association of Zimbabwe weighed in.
RPA said Cimas had accused some of its members of fraud, an allegation that had not been proved as yet.
“The RPA notes and is deeply concerned about recent attacks on the character of practitioners in the sector that have been orchestrated by allegations of fraud by Cimas Medical Aid Society.
“As RPA, our members are guided by strong ethical principles and guidelines. If there should be any member flouting rules and regulations, we should appreciate if they were identified because the RPA condemns in the strongest terms criminal activity by any of its members and indeed anyone in the industry.
“So to this end, RPA is worried that substantiation of said allegations has taken long thus delaying the process of censuring those found on the wrong side of the law tarnishing the good standing of the profession,” read part of the statement published last week.
The association said it is prepared to meet healthcare funders to “engender mutual trust” so that the public could access services without necessarily having to pay cash.
When contacted for comment on the latest developments, Cimas’ group operations executive Mr Vulindlela Ndlovu accused this paper of trying to cast aspersions on the society’s integrity.
“There is no need for further information. You wrote your article without seeking comment from us on the pertinent issues. What you need to do is advise your readers of the correct position as regards the Napaz circular and also acknowledge to them that there were no grounds for suggesting, as you did, that the reasons afforded by Cimas to Corporate 24 for terminating the arrangement with it for direct payment were anything but genuine.
“We believe an apology would be in order for casting such unwarranted aspersions on our integrity,” said Mr Ndlovu in an e-mailed response.
Cimas’ stand-off with Corporate24, which has not taken allegations of fraudulent claims by the society lightly and is believed to be considering its options, is still on-going.
Snowballing complaints
Complaints against Cimas continued to snowball last week.
Some practitioners, who chose to remain anonymous for fear of being victimised, said Cimas had on June 30, 2015 advised patients accessing specialist services such as CT, MRI and ultrasound scans that such services requested by a general practitioner would not be paid unless the GP was stationed at an emergency centre with facilities on site.
The communication by Cimas MD Mr Rodrick Takawaira also indicated that the scan should be done by a specialists and any done by a GP would not be paid.
GPs alleged Cimas was essentially usurping Government’s role of assessing service providers’ competence. Zimbabwe has about 10 practicing radiologists, while ultrasonographers are also in short supply.
“Declining to pay ultrasonographers without a radiologist back-up punishes all the members out of town. Secondly, it punishes the bulk of the medical aid society’s low package members. These guys stay in high-density suburbs and mainly use GPs for most of the services.
“To the GP who attended courses or programmes to enable them to do ultrasound scan, what are they going to do with the machines. Some of the machines were brought with asset finance from banks; how are they going to the loans…
“This move is a snub to specialist gynaecologists and obstetricians who have done sonography through courses and were carrying out gynaecology and obstetric-related sonography in their rooms as Cimas will not pay those claims.
“They are provisions within the law in terms of tariffs that these professionals can use to claim for these services, which are far less than what specialist radiologists would charge. So why are they refusing to pay,” said the practitioners.
Online Reporter