FAITH NDOU
MASVINGO-The Zimbabwe Medical Association (ZiMA) has strongly defended its recommendations to Parliament that medical aid societies be prohibited from owning healthcare facilities, arguing that the current system has fueled anti-competitive practices, weakened healthcare delivery and increased the burden on patients.
Critics of the current system argue that for medical aid societies to own healthcare facilities create conflicts of interest and distort competition within the healthcare sector.
Speaking on the association’s submissions to the Parliamentary Portfolio Committee on Health and Child Care, ZiMA President Dr Kudzai Masinire said the organisation’s position reflects concerns shared across the healthcare sector and is not limited to doctors alone.
“ZiMA is an umbrella body housing all medical doctors of all specialties in Zimbabwe,” said Dr Masinire.
“In our engagement with Parliament, we invited physiotherapists, pharmacists, dentists and radiographers through their professional associations. We also invited the Association of Healthcare Funders of Zimbabwe (AFHoZ), which is a grouping of some medical aid societies.”
According to Dr Masinire, healthcare financing remains a critical pillar of the health system and reforms are needed to strengthen both service delivery and health financing.
“Doctors are at the intersection of policy, science and service. Health financing is a critical pillar of the health system and ZiMA advocates and supports reforms that will strengthen service delivery and health financing,” he said.
He argued that many of the challenges facing Zimbabwe’s health sector can be traced to what he described as “vertical integration”, where medical aid societies own healthcare facilities while also financing healthcare services.
“On many forums over the past two decades, ZiMA has highlighted a myriad of challenges in the sector whose aetiology is vertical integration. If we are serious about transformation and national development, particularly the health sector narrative, then we ought to deal with the monster in the sector,” said Dr Masinire.
Dr Masinire accused some medical aid societies of engaging in monopolistic and anti-competitive behaviour, saying the practices have negatively affected both patients and healthcare providers.
He alleged that medical aid societies have ignored government efforts to regulate consultation and hospital fees since the publication of General Notice 159 of 2014 by the Ministry of Health and Child Care.
“The ministry issued a notice to regulate consultation fees and hospital fees but AFHoZ and its members refused to recognise the new tariffs, arguing that the regulations did not compel them to pay the new rates,” he said.
According to him, this resulted in some patients being forced to make co-payments or pay cash upfront despite belonging to medical aid schemes.
He further alleged that some medical aid societies established their own tariff structures and adopted a system in which they determined whom to pay, how much to pay and when payments would be made.
“They have continued to implement a ‘we pay what we want, whom we want and when we want’ system,” he said.
Dr Masinire also claimed that healthcare providers, including doctors, pharmacists, radiographers and hospitals are required to pay registration fees to access medical aid clients, while payment delays by medical aid societies place financial strain on service providers.
He alleged that delayed payments have contributed to co-payments and in some cases, refusal by healthcare providers to treat patients covered by certain medical aid schemes.
Among other concerns, ZiMA accused medical aid societies of channelling patients to healthcare facilities and practitioners of their choice, thereby limiting competition within the sector.
Dr Masinire said failure to address the issue through legislation could worsen healthcare inequalities and increase out-of-pocket healthcare costs for Zimbabweans.
“If not addressed at legislative level, it will lead to a legacy of catastrophic health expenditure at the pleasure of a few oligarchs,” he said.
He added that Zimbabwe should move towards Universal Health Coverage (UHC), which seeks to ensure that all citizens have access to quality healthcare services without suffering financial hardship.
ZiMA maintains that prohibiting medical aid societies from owning healthcare facilities is necessary to restore fairness, accountability and competition within the healthcare sector while improving service delivery for patients.
AHFoZ’s submission argues the opposite: that vertically integrated healthcare structures are not only lawful and globally recognised, but increasingly necessary in a high-inflation environment characterised by supply shortages, rising medical costs and overstretched public infrastructure.
One Julius Duma wrote in support of AHFoZ’s position saying private doctors stand to benefit directly from the changes if the Bill sails through hence their position.
Duma added that private health care facilities always incur shortfalls which is a burden on the patient.
He argues that more than 10 000 jobs will be lost if medical aid un health facilities are closed.
He writes:
Dressed in constitutional language and adorned with references to the World Health Organisation and the South African Medical Schemes Act, ZiMA’s document reads like a dispassionate policy brief from a neutral public-interest body.
Except that it is nothing of the sort.
ZiMA’s paper is a lobbying document from an organisation whose members — independent doctors — stand to gain directly and materially from the regulation it advocates.
That does not automatically make its arguments wrong.
But the paper’s refusal to acknowledge this interest, while presenting itself as a guardian of patients, should concern every parliamentarian who reads it.
Who benefits?
Let us begin where ZiMA’s paper does not: with the question of cui bono — who benefits?
If medical aid societies are forced to divest from their clinics and hospitals, the immediate winners are independent healthcare providers, who would inherit the patient volumes currently served by medical aid-owned facilities. Independent healthcare providers are overwhelmingly ZiMA’s own membership.
ZiMA frames the entire debate as one of patients versus profit. Yet it overlooks recent reports that more than 10 000 jobs could be lost, and over US$200 million in healthcare investment wiped out.
At an AHFoZ engagement, a representative of the Institute of People Management of Zimbabwe cited the case of a patient who avoided a US$600-per-night shortfall at a private hospital after being transferred to a medical aid-owned facility, paying just US$30 after three days.
“That kind of cost protection is what is at stake,” she said.
ZiMA’s paper does not engage with this reality. It does not ask: where will these patients go? What will they pay? Who will absorb them?
These are not minor omissions. They are the central questions of the debate.
The four harms that never happened
The heart of ZiMA’s argument rests on what it describes as four “real patient impacts”: a delayed referral, a missing test, a trapped civil servant and an early discharge.
These are presented as self-evident truths — vivid, emotionally charged scenarios that any reader would find alarming.
There is just one problem: not one of these examples is supported by evidence.
There is no case study.
No patient complaint record.
No clinical audit.
No Health Professions Authority finding.
No date, hospital, or outcome.
ZiMA asks Parliament to accept these as “real” impacts based, at best, on clinical intuition and, at worst, adversarial speculation about how medical aid-owned facilities must operate.
In a submission asking Parliament to prohibit an entire category of healthcare investment, the absence of even a single documented case is not a minor gap.
It is a disqualifying one.
If these harms are as systemic as ZiMA claims, where are the complaints? Where are the negligence cases?
The silence is telling.
