Medical aid societies, members warned
THE Medicines and Dental Practitioners Council of Zimbabwe is concerned with medical aid societies for continuing to refer patients to specific practitioners, saying this is against standard procedures of patient referrals.
It further warned its members to desist from such practices.
In a recent statement seen by The Herald, MDPCZ registrar Mrs Josephine Mwakutuya said some medical aid societies were referring patients to other practitioners without prior communication with the initial attending practitioner.
The standard operating procedure is that a patient seeks medical attention from a general practitioner of choice, who then refers the patient to a specialist for specialist services, should the need arise.
But of late most medical aid societies were referring patients to medical practitioners whom they would have entered into agreements with, infringing on the patient’s right of choice.
Mrs Mwakutuya said any practitioners who will be found wanting on this issue will be held accountable for their actions.
“Council at its meeting held on 26 September 2017 took great exception to this unethical conduct by such practitioners who continue to get orders from medical aid societies.
“I have, therefore, been directed by Council to advise that practitioners, who disregard the standard referral procedures by taking orders from medical aid societies will be held accountable for their actions,” she said.
Cherry picking of service providers by medical aid societies was prohibited in 2010 by the then Deputy Minister of Health and Child Care, Dr Douglas Mombeshora, when Cimas had a brush with Lancet Laboratories.
The regulator then ruled that Cimas was not supposed to direct its clients to particular service providers, describing the act as “unfair practice” in the medical industry.
The allegations are also at the heart of the tiff between Cimas and emerging hospital services business, Corporate24.
In 2015, Cimas controversially decided to stop honouring claims from Corporate24 over four disputed claims, notwithstanding the fact that the latter caters for more than 30 000 Cimas Medical Aid Society members.
To date, Cimas subscribers continue to pay cash for medical care at Corporate24 facilities as the two-year tiff between the two businesses continue unabated.
Corporate24 believes that the medical aid’s move was calculated to shepherd patients to its own facilities.
Statutory Instrument 330 of 2000 and SI 35 of 2004 make it illegal for medical aid societies to direct their members to particular service providers.
The case between the two businesses is now playing out in court.
Government has already begun consultations for a draft Medical Aid Societies Bill that is expected to regulate health insurers in the country if promulgated into law.
During the consultations, input to the draft Bill will be gathered from all registered healthcare providers, health insurers and consumers.
After the consultations, Government would then collate all the input from stakeholders, which would then be submitted to the Attorney-General’s Office for final adjustments.