Ordinary people bear the brunt of doctors, medical aid standoff

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A PALE-LOOKING Esther Zombo (61) is battling lung cancer and has no savings to pay cash upfront to a specialist doctor.

By Hazel Ndebele

Although she is cushioned to some extent by her medical aid, the shortfalls she has to pay have drained her finances. Her situation is aggravated by the fact that her employer is four months in arrears with her salary.

The situation for Zombo and many other Zimbabweans in her position could, however, take a turn for the worst as an impasse between the Zimbabwe Medical Association (Zima) and health insurers has resulted in private doctors insisting they will stop accepting medical aid cards with effect from today.

Zima, a body representing doctors in private practice, this week reaffirmed its position that from today, private doctors, hospitals and other health providers will stop accepting medical aid, as they seek payment of US$$220 million that they are owed by various health insurance firms.

The doctors are insisting on cash upfront from patients unless the government revokes operating licences for defaulting health funders.

Most medical aid societies were given six months operating licences which expired yesterday.

But while the health insurers and doctors haggle, ordinary Zimbabweans like Zombo are likely to feel the pinch, as most do not have cash upfront to pay for their medical bills.

“I am clueless on where I am going to get the money to cover my treatment costs as I have to undergo chemotherapy sessions regularly,” a depressed Zombo said.

“I was shattered when I heard that doctors will stop accepting medical aid from July 1 because I am already struggling to cover the shortfall. Where in the world am I going to get the money for treatment?”

The demand for cash payment has come at a time the country is in economic dire-straights which have been compounded by a liquidity crunch and cash shortages.

Terminally ill patients like Zombo will be hard-hit by the cash demand as they require large sums of money for treatment.

An oncologist told Zimbabwe Independent that radiotherapy costs between US$3 000 and US$4 000 for an entire course, while chemotherapy sessions costs between US$100 and US$1 000 per cycle, depending on the stage which the cancer has reached.

A patient may need a minimum of six cycles, but these can go up to 12.

Zombo says the move by doctors will greatly affect her health. She also said that the move is going to affect her family members who are registered under her medical aid.

“My husband does not have a formal job which can pay medical aid for him so he and my two children as well fall under my medical aid. We are all in this situation,” she said.

Zimbabwe has 31 medical aid societies, while an estimated 1,2 million people on health insurance.

The insistence on cash will therefore affect a significant chunk of the population which has been relying on private doctors and institutions for treatment because of the poor state of public hospitals. Public hospitals have become associated with a shortage of health personnel and drugs as well as poor service delivery.

Zimbabwe Association of Doctors for Human Rights (ZADHR) chairperson Rutendo Bonde said the state is responsible for the collapse of government hospitals whose services continue to deteriorate hence the dependency on private care by the general public.

Zimbabwe’s public health sector, Bonde said, has been deteriorating for the past 20 years due to various reasons such as brain drain where doctors have moved to other countries where there are better working conditions.

“The root cause of this medical aid issue is the fact that private care is so important to any Zimbabwean due to the collapse of the public health institutions,” she said.

“In any economy private health care is for the elite, but in the case of Zimbabwe, almost everyone seeks medical treatment in private hospitals which are definitely expensive and will require one to have a medical aid.”

Bonde said government has to be decisive to solve the impasse given that negotiations have been going on for more than 20 months without a solution.

“The state has to protect its citizens and make sure they have access to quality health care, negotiations have been going on for too long and this does not demonstrate a state which has its patient’s rights at heart,” she said.

She said doctors on the other hand have been sacrificing their needs in trying to serve social interests for too long.

“Any business has to be viable and cannot operate on losses,” said Bonde.

She said the move by doctors is only because they comply with tax laws and hence they seek to be paid money they are owed by medical aid societies.

Zima in a statement this week said patients who are not able to pay cash would be attended to, but only to be stabilised before being referred for comprehensive care at public health institutions.

Outlining reasons for Zima’s decision the body’s secretary-general, Shingai Bopoto said: “Medical aid societies are not paying claims. Some have gone for three years without paying service providers. This means doctors have to look for funds from elsewhere to pay tax that is due. As a profession, we don’t want to have doctors being prosecuted for not paying tax and at the moment, one way out is doctors can charge cash for all services,”.

Association of Healthcare Funders Zimbabwe (Ahfoz) chief executive Shylet Sanyanga said an engagement process was underway and refused to comment further.

However, President Robert Mugabe at the burial of Retired Brigadier–General Felix Muchemwa a fortnight ago criticised doctors for demanding cash up front, blaming doctors for not putting patients first.

“Well, our doctors were not being paid and that was their sacrifice on the part of Dr Muchemwa alongside the other doctors. But today what do we read? We read of a standoff between doctors and medical insurers. We never cease to wonder what has become of the Hippocratic Oath that demands that care must nevertheless to be given to the sick even where you are being paid less. Have our doctors lost their values that used to define them?”

Mugabe may be right or wrong in his assessment, but ordinary Zimbabweans want a speedy resolution to the impasse so that they access health care.

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