By Tonde Maruke
Zimbabwe’s new Medical Services Amendment Act introduces one of the biggest changes to private healthcare in years. Its most consequential change is a new rule that bars private hospitals from turning away emergency patients who cannot pay.
The law says a private health institution “shall admit any patient who is suffering from a condition which causes an immediate danger to the life of the patient” for “a period of not less than 48 hours for the purpose of stabilising the patient” before transfer to a government hospital.
The Act defines an emergency as treatment needed for “a life-threatening but reversible deterioration in a person’s health status”.
In practice, it means a road accident victim can be rushed to Avenues Clinic or Borrowdale Trauma Centre with no medical aid and no cash. Previously, the clinic could demand a deposit upfront and point the ambulance towards Parirenyatwa Hospital. Now the hospital must admit the patient, stabilise them for at least two days, and only then transfer them to a government hospital “which has the capacity to provide the required medical treatment”.
The law goes further. The Minister of Health may also “request” a private hospital to open its specialist facilities, such as ICU beds or dialysis units, to patients originally admitted at government hospitals during a public emergency. Refusing to accept a patient would attract a fine, up to a year in prison, or both, for the head of the institution, or for a practitioner acting without the head’s authority.
So who pays?
The law is meant to even the ground between the haves and the have-nots. This is key in an increasingly unequal society. Still, someone has to pay the bill, right? On cost recovery, the law says only this: “The Minister and the concerned private health institution may conclude or facilitate the conclusion of an agreement, for the recovery of all or portion of costs of the treatment of the patients referred to…whether from the patients or State.”
Read that closely. The Minister “may” sign a cost recovery deal. Nothing forces him to. The agreement may cover “all or portion” of the cost. So, even a signed deal could leave the hospital short. Recovery of the money can be “from the patients or State”, meaning a hospital could be sent to chase payment from the same patient who arrived unable to pay a deposit.
Impact on private healthcare
Two days in a private hospital bed, plus theatre time, drugs and staff, can run into thousands of US dollars per patient. Under this law, a private hospital must spend that money first and hope to recover it later.
The sector saw this coming. During public hearings, the Zimbabwe Association of Doctors for Human Rights petitioned against the clause, arguing that government’s record on reimbursement is poor. Local authorities are owed large sums by the State, and private institutions are businesses that cannot afford to have funds locked up for long periods, they said.
The doctors asked for a clear payment arrangement, or fiscal incentives such as rebates or tax credits, so that hospitals are properly resourced for emergency cases. They also warned that private hospitals could be overwhelmed if government facilities transfer too many patients their way. Above all, they said, the best solution is simple; government should first fix public hospitals.
Unfunded emergency care will not stay unfunded for long. Hospitals will look to recover it from somewhere, most likely through higher charges on paying patients and medical aid societies, setting the industry on a collision course with patients, and the government itself.
