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Tawanda Musarurwa
Health is vital, so much so that it is a right under the Zimbabwe Constitution, Section 29 (1 – 3) and in the spirit of universal health coverage, Government has an obligation and responsibility to ensure access to health services.
Health permeates every aspect of everyday life, most times even household expenditure.
Zimbabweans’ challenge – when health issues invade one’s wallet – is that the high costs of medical services are sometimes over the top. And even in cases where some people are covered by medical aid, the coverage is limited and the member is still burdened with significant shortfalls.
To this extent, Government has indicated plans to establish a national health insurance policy, which is very welcome.
All things being equal, a national health insurance (or ‘statutory health insurance’) seeks to ensure that a national population is covered against the costs of health care; this is especially critical in the local environment, which is highly informal, as it can bring the vulnerable under its wings.
Private medical aid is largely for those who can afford to consistently pay the monthly premiums. A national health insurance system should be less so.
This brings into question on how Zimbabwe’s own national health insurance can or will be funded.
Public Health and Policy specialist Enock Musungwini suggests that the national health system can be funded from the fiscus, without really creating new tax bands.
He also said the national health insurance should find a way to tap into the extensive informal sector.
“The national health insurance can be financed by different models including employee contributions, different tax regimes including sin tax for tobacco and alcohol companies, tax from mining and other extractive industries, a proportion of value added tax (VAT) and other agreed frameworks from a stakeholder consultative process,” said Musungwini.
“The national health insurance should also find innovative ways of tapping into the informal sector so that the base of contributions is huge. Like any insurance, the funding for the national health insurance for Zimbabwe should follow the principles of ‘the young ones paying for the old’ and ‘the healthy paying for the sick’.”
Initial indications were that the system would be run under the auspices of State-run pension fund, the National Social Security Authority (NSSA). But that is no longer the case, with reports that the national health insurance system will be operated under the Ministry of Health and Childcare.
Its placement under the Ministry of Health and Childcare, however raises more questions than answers on regulation matters, amid possible of conflict of interest.
In cases where a Minister or a permanent secretary in the Ministry are doctors by profession themselves, medical aid societies that are also offering service provision (such as CIMAS) may feel hard done.
There have also been reports where some private doctors and hospitals are setting up internal medical aid.
SO WHO IS BEST TO REGULATE?
The country’s insurance regulator, the Insurance and Pensions Commission (IPEC) has long been pushing to regulate medical aid societies; and this move is backed by a SADC protocol that entails all medical aid funders to be superintended by insurance regulatory authorities.
Zimbabwe has already ratified the SADC protocol, which was established in July 2009 by the SADC Ministers responsible for Finance and Investment under the Committee of Insurance, Securities and Non-Banking Financial Authorities of SADC (CISNA).
Currently, medical aid industry regulation is already provided for in the Medical Services Act Chapter 15:3, Medical Services (Medical Aid Societies) Regulations, 2000 and SI-330 (2000) as Amended by SI-35 of 2004.
Musungwini says “it is difficult for IPEC to regulate the health insurance or medical aid industry because of the sensitivity and complexity of the health sector and medical aid industry and the technical capacity of IPEC is a big question.”
Other observers think differently.
“Medical aid societies regulation does not require medical practitioners or any of the people identified thereof but the technical expertise such as actuaries, economists, legal practitioners, information communication technology experts and personnel with risk management background,” said one analyst who preferred anonymity.
Zimbabwe Medical Association (ZiMA) national treasurer Dr Sacrifice Chirisa is on record saying that IPEC would be a better option when it comes to regulating medical aid societies.
“The Ministry does not have the experience for regulation of the financial aspects of medical aid societies. IPEC does have some experience, ideally they can get a partial mandate,” he said.
Musungwini said Zimbabwe’s proposed national health insurance can draw some lessons and comparisons from neighbouring South Africa “where the regulation of medical aid societies is done by the Council for Medical Schemes.
“It is therefore imperative a regulatory body be set with statutory powers to regulate the industry rather than having a department in the Ministry of Health and Childcare,” he added.
But perhaps the biggest challenge facing the proposed national health insurance not regulatory, but rather how it will side-step macroeconomic challenges being faced by existing medical aid companies, particularly the issue of shortfalls.
Zimbabwe’s health funders have maintained that the shortfalls are a result of the pricing structure insofar as health service providers are pegging their charges to the United States dollar (and at the parallel market exchange rate) when medical aid members are paying subscriptions in the weaker Zimbabwe dollar, resulting in a significant mismatch.
“In terms of addressing shortfalls, the national health insurance should have two distinct and separate units with one for service provision and setting up different service units from hospitals, radiology centres, laboratory, and pharmacy services while the other unit will be responsible for financing and paying for services.
“The PSMAS -PSMI model though castigated by different service provider groups is a similar model that the national health insurance can follow,” suggests Musungwini.
“The hyperinflationary environment that was experienced prior to June 2020 creates uncertainty and erodes the purchasing power of members’ contributions. The acceptability of the medical aid card or national health insurance by service providers is another litmus test.
“Conflict of interest from both the health service providers and existing medical aid societies can be another challenge where each part will try to protect their turf.”
An effective national health insurance can help bring the majority of the excluded into the mainstream health system.
Online Reporter