FOR a long time the country’s biggest medical aid society by subscriber base, Premier Medical Aid Society (Psmas), has been in the news for all the wrong reasons, including issues to do with corruption and the rejection of Psmas membership cards by medical service providers. The organisation has, however, been going through a turnaround process. Zimbabwe Independent reporter Hazel Ndebele (HN) spoke to Psmas managing director Tendai Kapumha (TK) to discuss these and other issues. Find below excerpts of the interview.
HN: What progress has been made so far on the Psmas turnaround process?
TK: Thank you for that question, I think you will appreciate that Psmas has been going through various challenges. However, the turnaround process has brought improved access for our members, although we are not yet optimal, we are happy that they are now accessing services.
We have managed to build enough confidence to our providers through provider engagement, whereby some have eliminated and some reduced co-payments. We have also been educating our members to the extent that they now also understand what their benefits are, so that they are not abused by providers or they do not abuse providers. What we have done so far in the turnaround process has enabled our members to get seamless service at our offices. We prioritise our members more than anything else, hence we make an effort to pay the providers as much as possible from the resources that we have. The majority of the subscriber payments go towards paying service providers. You will find that we have also introduced Premier Lifestyle, a wellness programme premised on getting our members healthy.
We have also decentralised our services to ensure that all our members can access services from any branch in the country and not only in Harare. We have also partnered with certain healthcare facilities such as mission hospitals and local authorities medical facilities. We are in the process of also putting up mobile applications, so that our members can access services, even from their own offices. Also in the turnaround process, we have put in place a strategy that we are implementing, including culture change.
HN: Corruption is something which has rocked Psmas for a long time, what have you done to address this and what is the organisation doing to prevent future graft cases?
TK: We had an interim manager who was appointed to restore order and who dealt with most of the issues you are talking about through an Ernest and Young forensic report. Most of the issues in that report have been dealt with and some are still pending, but there is a path being followed. We have ventilated the organisation, put in new policies, new thrust and we are moving everybody into a culture which reflects our values, including integrity. We have also added the element of independent reporting of any seemingly corrupt activities by members (through) Tip Offs Anonymous and it is being done by Deloitte and Touche.
After putting our policies in place, we announced an option for those who think they cannot fit in the new environment. It was voluntary and it was an amicable separation. I believe that those who remained are committed in serving the organisation. We are focussing on insuring that we will not relapse into that element of the past.
HN: For a long time, Psmas medical aid cards were not being accepted at most medical institutions. What have you done to address that situation?
TK: The history sheds the reasons why we went into the hole, but like any turnaround you have to stabilise, fix and fund the business. Those three are very fundamental in any turnaround process. We have closed whatever leakages that were there and made sure that we pay providers. We have been very strict in terms of satisficing everybody.
Fortunately, subscriptions from our member organisations (government and private sector) have also increased and those that were not paying have also started paying through engagement, enabling us to have more resources for our providers. We have almost cleared the backlog and also working on paying the historical debt.
HN: Citizens often complain about huge shortfall amounts being charged at some medical institutions despite one having a medical aid card which they subscribe to every month. How has Psmas been dealing with this?
TK: Shortfalls are a very sensitive and emotive area because the expectation in the mind of the members is that the medical aid should always cover everything but even if you look at our rules and the constitution of the society, it does not state that we should pay everything. I will distinguish between a co-payment and a shortfall. A co-payment is what is needed by providers to cushion their cash flows; so, for instance, the provider knows that he may be paid in 60 days by the society, but would be in a cash squeeze, so let us say the patient is supposed to pay US$35 for a service, he or she may be told to pay US$10 upfront to access the services.
The members should then be refunded the US$10 by their medical aid society and in this case, Psmas would refund the member as they would have advanced payment on behalf of the institution. In reality, the service of US$35 has been paid by the society. We are educating our members that they should claim the co-payments they would have made. And then shortfall payments come in where a subscription we get actuarially by pooling it with others has a certain level of benefits that it creates mathematically but the service provider then chooses to charge more than what the medical aid society offers. This is done for various reasons, such as imported health inflation or the institution feels that is the value of their services or sometimes just being greedy. So, a shortfall is what the member is charged on top of a certain level of benefits that would have been internally determined or agreed. If the medical fund then pays all shortfalls it would then make a loss. If we were to pay shortfalls, it then means subscriptions would have to go up and which is difficult under this environment. Therefore shortfalls are inevitable.
HN: Sometime last year, Psmas launched a low-cost medical insurance package tailor-made for the informal sector. What has been the uptake?
TK: Our economy has had a battering at the last 15 years or more and most of our member organisations effectively closed. Most of the members who lost their jobs through company closures or retrenchments are failing to make ends meet. Most of them are now in the informal sector so we have created a product that would cover them given the nature of the cash flows. We tailor-made a product for just US$10 subscription per month. I would say it is early days, but very encouraging, we believe that the mechanism put on the ground should be able to harness and cover those people. The response shows that the market has been waiting for such a product.
HN: Has the Psmas membership been increasing or decreasing? Please provide us with the figures and what this means to Psmas?
TK: We are at 862 000 members and growing, last year we closed at 857 000 which obviously countered a few of those that dropped. We are almost at the million that we are targeting and beyond. What happens is that people may drop for different reasons other than company closures and these may include, perceived poor service because health is an emotional issue but such cases have been few.
HN: The country has been suffering an economic decline for a while now and this has seen most people struggle to pay for medical aid services. How does Psmas deal with defaulters?
TK: We have come a long way with most of our members and therefore, in such cases, we engage them and look at how best we can cover, given the available resources. We have agreed on a lot of payment plans and most of them are effective. We are simply holding each other’s hands in a flooded river. Once we are on dry land, we will recover.
Fact File: Tendai Kapumha
- Currently the Psmas managing director;
- Founding commercial director for Telecel Zimbabwe and was instrumental in setting up Telecel Uganda;
- Worked in Namibia as interim chief executive for Road Contractor Company;
- Worked as director sub-Saharan projects for a global multi-disciplinary engineering and science consulting firm, ARCUS GIBB;
- Registered as a professional engineer with the Engineering Council of Zimbabwe, a fellow of the Zimbabwe Institution of Engineers, as well as being the immediate past president;
- Holds a BSc (Engineering) Honours Degree from the University of Zimbabwe, a diploma in marketing and a Master’s in Business Leadership from the University of South Africa; and
- Married to Angeline with three children.