Medical aid societies need to pursue B2B engagements , where they approach individual health service providers to negotiate agreed prices, Cimas Medical Aid Society chief executive officer Vulindlela Ndlovu told journalists today (Thursday).
He said resuscitating the past practice of the medical aid industry and service providers agreeing on common tariffs was unlikely to work.
“We expect medical aids and the health service industry to agree on a price. Nowhere in the modern world does that happen,” he said, adding that those who provide services should market themselves. Fixing prices, he said, was anti-competitive.
“Should we allow price collusion in this day and age? I don’t think so,” he said. Mr Ndlovu also added that the discussion should not be about price but more about improving value to the patient. He added that value to the patient is maximised when the best outcomes are achieved at a fair cost.
He was speaking at the launch of a Cimas information campaign dubbed “Secure With Us”, at which the various services Cimas offers its members were highlighted, together with changes in the Cimas medical aid packages structure and other measures intended to meet the challenges posed by continually escalating healthcare costs.
Speaking at the same event, Cimas Medical Aid managing director Martin Mushambadope said Cimas had put together what it termed the Bluezone Network, a network of medical practitioners and health institutions with which Cimas had entered into a partnership to ensure that its members could access their services with minimal co-payments, depending on their medical aid package.
“The network includes hospitals, pharmacies, doctors and specialists,” he said.
Mr Mushambadope said Cimas had restructured its medical aid packages into three groups. There were three United States dollar denominated packages provided by Healthguard International, three comprehensive packages (Private Hospital Plus, Medexec and Prime) contributions for which would track medical inflation and fund performance monthly, and three standard packages (Basic, iCare and Private Hospital).
Mr Ndlovu emphasised that the restructuring and regrouping of these packages was intended to address the problem of continually rising healthcare costs resulting in high co-payments.
Other ways in which this problem could be mitigated was through members taking advantage of Cimas healthcare facilities, such as its primary healthcare clinics, laboratories, pharmacies and dialysis centre, where there were minimal co-payments.
He said Cimas welcomed the concept of creating a regulatory authority for the medical aid industry, as it will improve corporate governance in the industry, although he believed self-regulation was also necessary.
However, he expressed concern at suggestions that the Bill to establish such an authority would prevent medical aid societies establishing healthcare facilities. He said suggestions that there was a conflict of interest in medical aid societies providing healthcare services needed to be interrogated.
He suggested the establishment of healthcare facilities should be welcomed and asked rhetorically what was wrong with medical aid societies investing in healthcare provision.
He said some of the healthcare services provided by Cimas were introduced to fill a gap in service provision. The Cimas Dialysis Centre, for instance, was established at a time when there was need to improve access to dialysis services in the country.
Current legislation already barred medical aid societies from insisting on members using a particular facility. As long as that was adhered to, he failed to see where there was any conflict of interest.
Mr Ndlovu emphasised the primary responsibility for health lay with the Government. If public sector health facilities were not functioning well, it would be difficult for the private sector to function well, he said.