By Johannes Marisa
TECHNOLOGICAL innovation is something that can determine the direction of any organization. Managing change can be a daunting task, but with determination, nothing will fail. It is high time for Zimbabwe’s health system to adopt electronic medical cards spearheaded by Tres Group International (TGI). The objective is to have an efficient health system.
TGI is an organization operating in Zimbabwe that was established to optimize the healthcare industry and prepare it for the future through scalable innovation. The vision is to provide financial risk protection and access to healthcare in Africa. It is undeniable that there is evident acrimony between health funders and service providers in Zimbabwe.
The end result is a negative impact on patients who will be forced to shell out more money to close existing gaps. Application forms to Medical Aid Societies (MAS) have different fates which include Total Rejection, Partial Acceptance or Full Acceptance. The excuses given by the MAS are numerous.
Some of them include missing claim forms, inconspicuous paperwork, inadmissible signatures, wrong tariff codes, to name a few. Technological innovations are expected to accelerate many processes that involve service providers and MAS.
Medical practitioners, government officials and SAMs came together to discuss the technological innovation that TGI intends to introduce. It looks quite promising as it offers long-term solutions to lingering problems in the healthcare industry. The organization has created an instant payment platform for healthcare that will see doctors equipped with smart point-of-sale (POS) machines that will enable instant payment to medical service providers.
This will eliminate paper claim forms as well as term pricing, which will have a positive effect on disbursements. I liked the idea of fraud mitigation because the Smart POS has fingerprint facilities, facial recognition and iris scanner. If this innovation is embraced by both physicians and medical aid societies, the year 2022 will bid farewell to the acrimony between warring parties.
MAS are governed by the Medical Services Act (Chapter 15:13) which deals with both the registration and cancellation of medical aid societies. Different practitioners deal with SAM, including doctors, dentists, scientists, physiotherapists, occupational therapists, pharmacists, nurses, and medical psychologists.
The dispute between service providers and MAS has been going on for years and it is unpleasant. This has worked very much at the expense of smooth health care delivery, with patients bearing the brunt of resentment. Many patients think doctors are always to blame for inconsistent service, but healthcare funders have their share of the blame.
Apart from the question of payments, there are other issues that infuriate service providers:
Dictated to Service Providers — The bully mentality exhibited by some SAMs is disturbing and absurd. It is unfortunate that some SAMs refuse to honor certain medical investigations such as CT scans, if ordered by GPs.
I wonder if these MAS think that doctors are not qualified to determine whether a patient needs such a scan or not. Such kind of thinking that belittles our well-trained practitioners will not help lessen the acrimony but will add insult to injury.
Unilateralism on the publication of tariffs — DSOs have often been accused of unilaterally proposing tariffs that suit them. In 2015, the Zimbabwe Medical Association agreed with SAMs on special fees such as those for the initial consultation and subsequent visits. Unfortunately, the agreed tariffs were not applied by the MAS and the tension persisted.
There is no meaningful bargaining that materializes when one acts like a superpower to manipulate everyone. Service providers have often responded by flexing their muscles more in order to stay afloat, especially in this era of COVID-19 when the costs of running clinics, surgeries or hospitals are skyrocketing.
SAMs have also raised issues which I believe can be mitigated by the technological innovations to be introduced. These include:
- Fraudulent claims – There are cases of false claims that are allegedly sent to SAMs, but some patients have never been seen at the medical centers, a situation that no one tolerates. This practice should stop immediately if ever it was there.
- Patient overload – The issue of overload has come up many times but has grown in importance, especially in the era of COVID-19. While those not in the field may not realize how expensive managing COVID-19 is, practitioners will say the cost of sundries and medications is appalling. COVID-19 has brought misery and anguish. Service providers cannot remain viable when treating COVID-19 patients when some SAMs take a full two months to pay, but need money to buy drugs, disinfectants, personal protective equipment , pay salaries, including hazard allowances.
Let’s all embrace technology and innovation. The instant payment system will surely be accepted by many service providers.