Patients to cough up (& cough more) as doctors give medical aid ultimatum

This week, the first first family (for there has only been one… really.) continued to celebrate the birth of the newest addition to their multigenerational family in plush surroundings kusingapore (Could be Singapore or where politicians are healed, but continue to go as if havapore). Meanwhile, most Zimbabweans (in Zimbabwe) must continue to rely on a healthcare system that is sicker than those it is intended to serve. They can ill-afford a trip to the doctor – let alone to qSingapore. The juxtaposition of the lived realities of Zimbabweans is already stark. One would imagine it could not possibly get any worse…

but it could. 

From 1 July 2016, the Zimbabwe Medical Association announced that private healthcare providers will no longer accept medical aid if outstanding fees are not paid. In countries where healthcare is generally affordable to the masses and where the public sector actually provides healthcare, such a move would also not be welcome, but it certainly wouldn’t be the end of the world. In Zimbabwe, however, in the absence of public health insurance and a suffering medical sector, this move could be devastating.

Already many have no access to proper medical care because they cannot afford it (even those with medical aid). With the announcement that owing to a range of factors – key among them being forced to pay tax on bills that are yet to be settled by patients – private practitioners would only accept direct cash payments, many more will soon be left without access to good healthcare. According to ZiMA, private practitioners are owed over $220 million by various medical insurance companies.

ZBC reported that “ZiMA’s decision will put the lives of ordinary Zimbabweans at risk as they will fail to raise cash for medical care.” True, but did ZiMA jump or was it pushed? One must consider whether these medical practitioners can afford to keep their practices afloat Medical_Symbol,_Dollarswhen medical aid providers are not settling bills.

The government was quick to try allay fears, by saying that they would push medical aid societies to pay up within the stipulated time period. But this wrangle between private medical practitioners, government and medical aid providers is not new.

The Deputy Minister of Health and Child Care, Dr Aldrin Musiiwa, was quick to underscore that doctors would be breaking the law if they refused to assist people. He was likely referring to regulations related to medical care and medical aid read together with Section 76 of the Constitution that provides for the fundamental right to healthcare…

§ 76. Right to health care

1)    Every citizen and permanent resident of Zimbabwe has the right to have access to basic health-care services, including reproductive health-care services.

2)    Every person living with a chronic illness has the right to have access to basic healthcare services for the illness.

3)    No person may be refused emergency medical treatment in any health-care institution.

4)    The State must take reasonable legislative and other measures, within the limits of the resources available to it, to achieve the progressive realisation of the rights set out in this section.

… but this fundamental right is not for private practitioners alone to respect, protect and promote. It is also (if not more) for the state. Particularly, it places an obligation on the state to make concerted efforts to ensure Zimbabweans realise this right. So, what then?

Well, for starters, the state could argue that they do provide healthcare. In the public sector. In Zimbabwe. not in Singapore, South Africa, Malaysia or wherever else… and that all within Zimbabwe can and ought to use the public healthcare facilities. The state will lay blame on the doctors, pharmacists, dentists, radiologists, sanctions, and and and for denying Zimbabweans medical care and on medical aid schemes for not paying up. nurses

When shown the state of the public healthcare facilities, the state will say they are doing the most they can under the circumstances, but the economy is ailing and in need of emergency care itself because sanctions and regret that all they can do may be too little. Any acknowledgement of wrongdoing will be tempered by blame attribution to other people, other forces, other anythings. Dr Musiiwa has already done this. Blaming doctors, ZIMRA and medical aid societies… Nary a finger pointed at government itself, which coincidentally (essentially) “runs” the largest medical aid scheme in the country

But supposing the Zimbabwe Revenue Authority comes to at least part of its senses and announces before 1 July that they will only tax actual earnings (not mythical or projected ones on the basis of a bill), will that solve the problem? No. Supposing medical aid schemes committed to paying up… soon… would that do it? No.

The problem is not that private healthcare practitioners won’t accept medical aid – for they too must earn some sort of living and be able to continue providing some semblance of healthcare.

The problem is that people have no real access to healthcare as enshrined in the Constitution… and that when they do, it costs them a pretty penny (not bond coin).

The problem is that we don’t have enough apples in Zimbabwe to give to everyone to ensure that they eat that apple a day to keep they doctor away.

The problem is that the first family welcomes the newest addition to their multigenerational family in Singapore because even they won’t use Zimbabwean facilities.

The problem is that there are great medical practitioners in Zimbabwe (my brother is one), but they are few… and as providing healthcare in their own country becomes a bigger challenge, they could become fewer and fewer.

ZiMA has little to no option. It’s sink or swim… and they chose to try find a way to swim.

When elephants fight, it is the ground that suffers.

Ottilia Anna Maunganidze

OT
Ottilia Anna Maunganidze
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