Dr Johannes Marisa
Technological innovation is one thing that can determine the direction of any organisation. There is obviously noone who can get into OK supermarket and order a basketful of foodstuffs and then decide to pay two months later.
So many medical practitioners feel shortchanged when they do not get paid in time by medical aid societies that can stretch for even 90 days. Change management may be a daunting task but with determination, nothing will fail. It is time that Zimbabwe health system adopts medical E-cards that Tres Group International (TGI) is spearheading. The aim is to have an efficient health delivery system.
TGI is an organisation operating in Zimbabwe that was created to optimise the health care industry and set it for the future through evolutionary innovation. The vision is to provide a financial risk shield and healthcare access to Africa. It is undeniable in Zimbabwe that there is obvious acrimony in Zimbabwe between health funders and service providers.
The end result is negative impact on the patients who will be forced to fork out more money from their pockets to cover the existing gaps. Claim forms sent to medical aid societies meet different fate which include complete rejection, partial or complete acceptance. The excuses given by medical aid societies are too many. Some of them include missing claim forms, inconspicuous papers, ineligible signatures, wrong tariff codes to mention just but a few. Technological innovations should come in to expedite numerous processes that involve service providers and medical aid societies.
Medical practitioners, government representatives and medical aid societies met to scrutinise the technological innovation that TGI intends to introduce. It sounds quite robust and candid as it can proffer long term solutions to perennial problems of healthcare industry. The organisation has created a healthcare instant payment platform which will see medical practitioners being equipped with smart POS machines that will enable instant payment to medical service providers. This will eliminate paper claim forms as well as forward pricing with a positive effect on out-of-pocket expenses.
There is fraud mitigation because the Smart POS has fingerprint facilities, does facial recognition and has iris scanner with it. If that innovation is adopted by both medical practitioners and medical aid societies, then the year 2022 will sparge the acrimony between the warring parties. We will witness harmony in the medical industry sooner than later.
Patients will be issued with smart cards they can swipe on POS machines after full verification from their respective medical aid societies. Payment will be effected instantly without the need to fill any claim forms.
The Medical Aid Societies are regulated under the Medical Services Act (Chapter 15:13) that deals with both the registration and cancellation of medical aid societies. Different practitioners deal with Medical Aid Societies and among them are medical doctors, dentists, scientists, physiotherapists, occupational therapists, pharmacists, nurses and medical psychologists.
The tiff between service providers and medical aid societies has been lingering for years and it is unpalatable. This has worked much to the detriment of candid health delivery with patients bearing the brunt of the resentment.
Many patients think that the medical practitioners are always the ones to blame for disjointed service yet the health funders have their minacious ills on health service delivery as well. Other than the issue of payments, there are other reasons that infuriate service providers:
Dictation to service providers: The bully mantra shown by some medical aid societies is worrisome and absurd. It is unfortunate that there are some medical aid societies that refuse to honour some medical investigations like Computed tomography scans if they are ordered by general practitioners. I wonder if these medical aid societies think the doctors are not qualified enough to judge if a patient needs such a scan or not. Such kind of thinking that belittles our well-trained practitioners will not help alleviate the acrimony but will add salt to an injury.
Unilateralism on tariff gazetting: Medical aid societies have often been accused of unilaterally coming up with their tariffs that suit them. In 2015, the Zimbabwe Medical Association (Zima) agreed with medical aid societies on particular tariffs like initial consultation and subsequent visits.
Unfortunately, the agreed tariffs were not implemented by MAS and the tension persisted. Many medical aid societies treat service providers as docile people who cannot challenge anything from them. That is grossly ridiculous. Service providers have often responded by further flexing their muscles in order to remain afloat, especially during this Covid-19 era where the costs of running clinics, surgeries or hospitals are spiralling.
Medical aid societies have also raised some issues which I think can be alleviated by technological innovations to be introduced. These issues include:
Fraudulent claims: Fraud is a serious criminal case that has to be investigated and anyone caught should be punished. Ethical practice should be followed in order to give the best service to the nation. There are cases of false claims that are purportedly sent for processing. That should stop!
Overcharging patients: The issue of overcharging has been raised several times but has gained prominence especially during the Covid-19 era. While those on the ground might not realise how expensive Covid-19 management is, the practitioners will argue that the cost of sundries and medicines is horrendous.
Covid-19 has brought misery and anguish. Service providers cannot remain viable when treating Covid-19 patients when some medical aid societies take two full months to pay yet cash is needed to stock drugs, sanitisers, personal protective equipment, pay salaries, including risk allowances.
Let us all embrace technology and innovation. The instant payment system will surely be accepted by many service providers.