Health sector woes deepen

In a bid to keep up with escalating costs, Zimbabwe's medical aid societies increased their monthly subscriptions by more than 500 percent this week, further aggravating the country's health sector problems.

The latest increase follows a 400 percent rise in private doctors' consultation fees last month, when they said rocketing inflation had left them struggling to keep their surgeries open. Doctors also stopped accepting medical aid cards and demanded upfront cash payments for consultations with patients.

Consultation fees were raised from an average of Zim $26,000 (about US $6.36 at Tuesday's auction rate) to Zim $46,500 (about US $11.26) - a move commentators and economists said would effectively block access to health care for most cash-strapped Zimbabweans.

Agence France-Presse reported that doctors had complained that health insurance companies were not remitting funds to them on time, and were also not willing to fork out the new fees.

The government has since amended legislation to prevent private doctors from demanding upfront cash payments.

The latest increase announced by the 23-member National Association of Medical Aid Societies (NAMAS) puts a worker's monthly contribution to medical aid at Zim $100,000 (about US $24.50), up from Zim $13,000 (about US $3.18).

NAMAS vice-chairman Alban Williams said it was necessary to adjust medical aid subscriptions in line with daily running costs, and the latest increase would remain effective through the remainder of 2004.

Doctors and medical aid societies have been wrangling over fees for the past five months, resulting in both parties unilaterally imposing self-determined fee structures on subscribers and patients.

IRIN found that many doctors in the southern city of Bulawayo had cut ties with medical aid societies, and were still charging cash upfront in defiance of the government directive. A few said they had made personal arrangements with NAMAS and were offering selected services to premier medical aid scheme members.

DOCTORS MAY SEEK GREENER PASTURES

Doctors felt the amendment was a government attempt to introduce "a medical services version of the price controls", which would force more of them to quit the country and join the search for greener pastures abroad.

"The new amendment is a very unfair piece of legislation. When government starts enforcing it we
will effectively be under price controls. That would be bad for us and bad for the patients, because this amendment does not consider the costs we meet in the daily running of our surgeries. We have to use foreign currency to import most of the medical equipment and drugs," said one doctor.

"Although the forex supply situation has improved, things remain expensive as there has been no drop in prices. To expect doctors to provide services at far less than it costs them is an indirect way of asking them to leave the country. No one wants to operate at a loss or provide free services," the doctor added.

Doctors and legal experts said it was impossible to enforce the new laws in the absence of a gazetted fee structure. Contrary to public expectations, the government has not ordered a slash in fees, but Health Minister David Parirenyatwa warned that it might do so unless doctors and NAMAS reach an agreement.

"The amendment only serves to show that government is serious about regulating the medical services. We are serious, and we will soon prescribe the fees unless NAMAS and ZIMA resolve their dispute. Once we do that, nobody will charge anything else, or refuse to accept valid medical aid cards," said Parirenyatwa.

Paul Chimedza, the secretary-general of the Zimbabwe Medical Association (ZIMA), which represents medical practitioners, said imposing consultation fees on doctors could push them out of business. Government should first deal with the issue of late payments to doctors by medical aid societies - the wrangle over fees could end if NAMAS improved its system of payments.

Despite low fees, the public now shuns public hospitals, most of which have been crippled by critical shortages of drugs, equipment and staff.