|
Back to Index
Public
discussion forum report on the impasse between NAMAS and ZIMA
Community
Working Group on Health (CWGH)
February 20, 2004
Introduction
The Community Working Group on Health (CWGH) was formed in early
1998 to take up health issues of common concern. The approximately
twenty-five organisations in the CWGH include national membership
organisations that have branches across the country, whilst others
have area-specific membership (such as the residents associations).
The CWGH began
in 1998 a programme of work to disseminate information to, and organise
civic group members on health. It has carried out various community
meetings on health, discussed and prepared policy inputs on health
issues and carried out advocacy on those issues.
The programme
helped to achieve increased community awareness and participation
on health issues. The CWGH has now grown more focused and informed
in their health activities, and has become deeply rooted in the
community where the people are, and is now a major voice of the
voiceless on health issues, and a resourceful partner of the State
on National Health issues. The CWGH seeks to ensure that the health
sector is rebuilt from the bottom up, not the top down, and that
the lowest income communities are the first to see improvements,
and not the last.
It is under
this background that the CWGH organised a public discussion forum
on the impasse between the National Association of Medical Aid Societies
(NAMAS) and the Zimbabwe Medical Doctors Association on the 12th
of February 2004 at Jameson Hotel, Harare.
Speakers at
the meeting were drawn from the Zimbabwe Congress of Trade Unions
(ZCTU), NAMAS, ZIMA, Consumer Council of Zimbabwe, and Employers’
Confederation of Zimbabwe (EMCOZ). This report outlines major issues
discussed.
Presentations
1. Dr P. F.
Chimedza, Secretary General, Zimbabwe Medical Association (ZIMA)
Dr Chimedza, in
his presentation, noted that doctors are now accepting medical aid
cards from Premier Medical Aid Societies only, but the impasse still
remains with NAMAS members and from the look things, there will be
no solution for the foreseeable future and members of CIMAS and NAMAS
will continue to pay cash upfront. He said the problem emanates from
NAMAS, which have been dictating what the doctors must be paid, and
this is threatening the existence of doctors. He said doctors, like
other professionals must be allowed to charge what they feel are sustainable
tariffs and not to be told what they should charge. He said NAMAS
only looked at their profits margins at the expense of doctors.
Dr Chimedza
stated that they had initially agreed with NAMAS to determine tariffs
using the Consumer Price Index (CPI), but NAMAS later reneged and
claimed that the CPI was used by those who deal with food stuffs
only and they suggested that doctors use the Medical Price Index
(MPI). The doctors agreed, but after that was done, the MPI produced
results that were two to three times higher than those were produced
under the CPI. NAMAS, again, refused to accept the results and decided
that they go back and use the CPI. Despite using the CPI, NAMAS
members are still paying doctors fees that are way below the CPI.
It is at this
juncture that ZIMA commissioned a scientific study by Coopers Lybrand
and the results showed that doctors were underpaid by 1 000 percent.
Doctors then increased their fees by 400 Percent, giving a discount
of 600 percent. PSMAS agreed to pay this figure, but NAMAS refused.
Dr Chimedza
said 81 percent of doctors in Matebeleland alone have since left
practice with some leaving the country and others opting to go into
private practice because of poor conditions of service in government.
In concluding
his presentation, Dr Chimedza said it took NAMAS members up to two
years to effect payments on submitted forms and in some cases, doctors
are not paid with medical societies giving all sorts of reasons
like the member was not a paid up at the time of treatment. He warned
NAMAS that it would soon become irrelevant in the face of the changing
economic environment.
2. Mr. J. Chiviru
- Executive Secretary, National Association of Medical Aid Societies
(NAMAS)
Mr. Chiviru noted
in his submission that there are 600 000 members of medical aid societies
and about one million people are on medical aid schemes in Zimbabwe.
He said the problems of doctors must not be isolated with the prevailing
economic situation in the country, like that of the shortage of foreign
currency. Doctors' incomes, like that of anyone else, have been eroded
by the economic factors affecting the country and that cannot be blamed
on NAMAS.
Mr Chiviru said
while ZIMA tariffs increased by 400 percent in January, whilst the
salaries of most employees, who are the majority of contributors
to medical aid societies, went up by an average of 50 percent. He
said incomes of most contributors are too low and NAMAS will not
be able to cover the defence between the income they get from contributors
and the demands of doctors. He said 90 percent of all monies that
is collected by medical aid societies go towards payment of bills
and only 10 percent is put to use in administration.
3. Mr. Mukuchini
- on behalf of Mrs R. Mpofu Consumer Council of Zimbabwe (CCZ) Executive
Director
CCZ expressed concern
at the impasse between ZIMA and NAMAS over the recent increase in
consultation fees and ZIMA's refusal to accept medical aids cards.
The CCZ said there was need for dialogue to continue and unity of
purpose between NAMAS and ZIMA. Consumers need an explanation from
medical aid societies on the delays in payment after treatment.
The CCZ said
the rights of patients are being infringed upon by the doctors'
demands for cash upfront. The CCZ noted that there have been numerous
complaints from consumers about the unrealistic nature of NAMAS
tariffs. It also called upon the government to put in place some
legislative mechanism to protect consumers and doctors who have
been greatly affected by the delays in refunds and payments.
4. Mr. W. Chibebe
- Secretary General, Zimbabwe Council of Trade Unions (ZCTU)
Mr. Chibebe told
participants that the ZCTU was concerned with the impasse as workers,
the major contributors to medical aid societies, are suffering. He
queried why some medial aid societies are sponsoring soccer tourneys
yet; they are failing to pay doctors. He also said doctors must also
have a human face as there are some doctors who are overcharging patients.
He said the
ZCTU might consider teaming up with EMCOZ and establish a medical
insurance institution to rival medical aid societies that will cater
for the welfare of workers' health. He also said doctors should
also consider forming their insurance company to rival medical aid
societies.
5. Mr. M.C.
Bimha - President, Employers Confederation of Zimbabwe (EMCOZ)
Mr. Bimha said
the impasse between NAMAS and ZIMA has also affected EMCOZ since
in most cases employers also contribute a percentage of employees'
medical aid. Mr Bimha said illnesses among workers greatly affect
productivity and that in all organisation employers will always
strive for a healthy workforce. He said workers are now borrowing
cash from their employers to meet their medical requirements. He
said despite the economic downturn, a solution should be found to
solve the problems facing the country. He said EMCOZ is prepared
to meet both NAMAS and ZIMA to try to find a solution.
6. Hon. B. Chebundo
MP, Chairperson, Parliamentary Portfolio Committee on Health
In his presentation,
the Hon Chebundo looked at the "impasse between NAMAS and ZIMA
in the context of three parties as an equilateral triangle to the
dispute:
1) People/Clients
- who contributes timeously to NAMAS and get treatment from ZIMA
and drugs from pharmacists.
2) ZIMA and Pharmacists - who treat people and claim from NAMAS
and they should be paid timeously by NAMAS.
3) NAMAS - who administer clients' money receives monthly contribution
and who are expected to pay claims without delays.
Hon. Chebundo
said problems cited in the medical field in the impasse between
the two parties include failure by NAMAS to honour claims timeously,
exorbitant charges by doctors, upfront payment demands by doctors;
double payment by clients (To NAMAS and ZIMA) thereby straining
clients pockets.
He noted that
whenever there is dialogue between the three parties it was important
to note the following on each partner:
a) Medical
aid societies. Why they exist, their role in administrating medical
insurance, the flow of clients' money, problems on timely remitting
clients' money, transparency in terms of profits made and costs
incurred during operations.
b) Doctors. Why they exist, professional service rendered operational
costs and how they arrived at those costs.
c) Clients (people). Their rational fore joining medical aid schemes,
double payments to both ZIMA and NAMAS and the problems encountered
during claims.
Hon Chebundo
emphasised that there is need for transparency and professionalism
in the way all partners conduct their business. It is lack of transparency
that makes people doubt whether things are done in good faith. Medical
aid societies have an obligation to make clients know what is involved
in their business that involves clients' money; what problems they
face, what profits and how they assist to cushion clients' shortfalls.
He noted that
in the past there were no such problems between medical aid societies
and doctors because the arrangement was that doctors owned the whole
system.
Hon. Chebundo
said the Parliamentary Committee would consult widely on the impasse
and make a recommendation to Parliament in order to fill in loopholes
in the legislation that exists. The committee was also considering
a commission of enquiry on the impasse.
Discussions
The following
observation noted during the question, and answer and discussions
period.
There was a
general concern from the public present at the meeting where issues
pertaining to lack of justification to the use of Medical Aid contributions.
After claims by NAMAS that it has membership of up to 600 000 Medical
Aid beneficiaries the floor questioned the use of their collective
pull of contributions, "If you have 600 000 medical aid beneficiaries
and each member contributing ZWD10'000 monthly, then NAMAS would
realise 6 billion dollars each month and still no justification
to the breakdown of expenditure".
The floor also
assented that the public, who are the core reason for both party's
relevancy and existence are therefore the most affected since there
is not much disposable income available to them hence there was
need for increased involvement of the beneficiary. There was no
need for NAMAS and ZIMA to fight at the expense of the beneficiaries.
There was an
increased call for the medical aid beneficiaries to realise their
legal rights to claim services for their contributions.
In addition
to the forum, the floor also acknowledged the current economic problems
but felt that ZIMA should put on a human face and find solutions
that are in the best interest of the public.
In addition, the following observations were put forth for debate
- NAMAS increases
fees without consulting contributors.
- Clients have
to find out if they have a legal right to sue NAMAS for accepting
clients' money when there is no service
- Doctors must
form their own medical insurance company
- There is
need for a human face among doctors
- There is
need for a commitment from NAMAS that the dispute will end
- There is
a communication problem between NAMAS and ZIMA.
The chair of
the forum, Mr Mawire said the forum brought to the fore five distinct
issues:
1. The legality
of the dialoguing framework between NAMAS and ZIMA
2. The Economics of the impasse
3. The constitution of the ZIMA and NAMAS and how they are regulated.
4. The impact of the impasse on the beneficiaries and the society.
5. The role of the government in the impasse was not clear
Mrs. Edina Masiyiwa
(Woman's Action Group) and the current Chairperson of the Executive
Committee of the CWGH officially closed the night's proceedings
with a vote of thanks where she acknowledged all participants and
the obvious concern in matters that involve Health.
Visit the CWGH
fact sheet
Please credit www.kubatana.net if you make use of material from this website.
This work is licensed under a Creative Commons License unless stated otherwise.
TOP
|
