Health care costs have shot up substantially with cash-paying patients now having to fork out over $4 million to see a specialist doctor while medical aid beneficiaries will be required to make co-payments of up to $2 million.

The new round of increases in charges by between 80 percent and 110 percent will make medical services unaffordable to the poor.

The increases come at a time when wages and salaries of the majority of workers have dwindled because they have fallen behind the inflation rate.

The annual inflation rate is now at more than 500 percent, and the poverty datum line has risen to close to $17 million whereas the majority of workers earn an average of $2 million.

Already some medical aid societies have increased monthly contributions by between 85 percent and 90 percent with effect from February 1, 2006, a move that will further erode disposable incomes.

Patients paying in cash would now have to fork out $4 144 000 to see a specialist doctor (physicians, pediatricians, consultants and other practitioners in that category) in consultation fees while they will need $2,7 million for a review.

Patients were already paying $2 080 000 for initial specialist consultation and $1,5 million for subsequent visits.

Medical aid societies would pay $2,1 million for the beneficiaries but medical aid cardholders would pay the shortfall of $2 million for specialist services to make it $4,1 million.

The latest round of increases would impact heavily on those paying cash, but patients on medical aid would also feel the pinch owing to the huge disparity in the fees medical aid societies would pay to doctors and the resultant shortfalls to patients.

Cimas, the largest private medical aid society in the country, raised contributions for its private hospital package and "Medexec" brand (tailored for top executives) from $1,5 million to $2,8 million and from $3,6 million to $6,9 million respectively.

Lower range products were increased as follows: "Basicare" from $63 000 to $117 000; primary package from $156 000 to $289 000; and general package from $474 000 to $877 000.

The Basicare and primary package provide for access to Government, mission and municipal hospitals and clinics as well as private general practitioners.

This would mean that a worker earning less than $2 million and with three children plus member and spouse would have to pay close to $600 000 in medical contributions - 30 percent of his salary.

The Premier Service Medical Aid Society (PSMAS) -- whose membership mostly comprises civil servants -- had not announced new contribution rates and by last year members were not required to pay any cash upfront or co-payments on receiving health care services at all health institutions owned by the medical aid society.

However, civil servants, who have not been awarded an increment since January last year, will be the hardest hit if the PSMAS increases contributions.

Many people were shocked by the increases and said the latest increases would force many to die in their homes or be forced to seek help from spiritual and traditional healers.

Others reacted angrily and urged the Government to intervene.

"Shortfalls will hurt the ordinary contributor most," said Mr Adrian Kabunze, who works in stationery shop in the city. "Right now, if I fall sick where will I get $2 million needed by specialists as cash upfront?

The chairperson of the Association of Healthcare Funders of Zimbabwe (AHFoZ) Ms Florence Kazhanje said the increases across the board were necessitated by inflation, devaluation of the dollar and the need to adjust incomes for medical practitioners.

"We have been forced to increase the fees because of inflation and the costs imported from the devaluation of the dollar, which has exposed medical disciplines such as radiology and dental services that depend on imported materials," she said.

The Zimbabwe Medical Doctors' Association (Zima) -- a grouping of specialist doctors and general practitioners -- also announced new rates of up to 200 percent.

Zima no longer negotiates for rates with AHFoZ following disagreements they had last year over the amounts doctors got from medical aid societies.
Zima now decides new rates on its own.

The PSMAS rejoined AHFoZ last year after nine years out of this medical aid grouping following disagreements over high consultation fees charged by doctors.

The increases came after intense negotiations between AHFoZ members comprising a total of 22 medical aid societies made up of in-house schemes, eight open fund schemes, private hospitals and medical practitioners in three specialist disciplines.

According to the Zima schedule, review visits would now cost $1,9 million while the medical aid society would pay $783 000.

However, a visit to a general practitioner would see a patient forking out $2,9 million and $1,9 million for subsequent visits.

In an interview yesterday, Zima president Dr Billy Rigava said the increases had been necessitated by the highly inflationary economic environment.

"In coming up with the increases, we have looked at the operating environment where rentals have gone up by over 1 000 percent and the general increase in administrative costs.

"The weakening of the Zimbabwean dollar has also been taken into consideration, especially so in the case of machinery and medicines that need foreign currency such as radiology equipment and reagents, among others," said Dr Rigava.

He said the continual upsurge in the consumer price index had also contributed to the tariff increases.

Modalities for the payment of doctors by medical aid societies, he said, had to be taken into consideration if the burden on patients was to be minimised.

AHFoZ has increased fees by up to 110 percent - a situation that would leave patients with huge shortfalls to settle each time they visit their doctors or private health institutions.

The much higher tariffs charged by private hospitals and doctors has resulted in patients swarming public health institutions - in the process diminishing their capacity to effectively provide services.

Medical aid societies have been at loggerheads with doctors over consultation fee shortfalls, which in some cases has seen doctors demanding cash upfront or passing on shortfalls to patients.

Doctors and medical aid societies recently agreed to put their differences aside and address the issue of tariff differentials.

Tariffs for private health institution went up by up to 87,5 percent for various services offered.

Fees for accident and emergency services now range between $527 000 and $2,9 million per day depending on the service sought by the patient in this category.

Private health institution would now charge between $5 400 and $137 800 per hour for anaesthetic drugs and gases and between $3,6 million and $19,3 million for administering critical drugs to patients.

Patients with kidney ailments now have to pay $5,4 million for dialysis per session in a private health institution while charges of maternity services have been hiked to range between $596 000 and $4,6 million a day depending on the services sought.

Maternity complications charges are now in the $724 000 to $2,9 million per day range.

Tariffs for mine, industrial and commercial clinics also went up by up to 87 percent.

Initial consultation for general practitioners is now $864 000 and $2,1 million for specialists.

Hospital service rates for the Parirenyatwa Group of Hospitals also went up by a similar rate.

Ward fees now range from $830 000 up to a maximum of $2,4 million per day depending on the services sought by patients.

Maternity fees also shot up to a range between $600 000 and a maximum of $2,8 million depending on the services offered, according to the schedule released by AHFoZ.

Critical care charges now start from $2,4 million up to a maximum of $5,7 million while costs for accident and emergency cases now range from $138 600 to $553 000 a day.

Upper range operating theatre costs are now between $469 900 and $1,5 million a day.

"This will adversely affect our members whose disposable incomes are dwindling and yet costs for the provision of health services are rising due to inflation," said Ms Kazhanje.

"This translates to more serious problems for our members."

However, a survey by The Herald established that most general practitioners operating in high-density suburbs had not adjusted their consultation fees to the levels recommended by AHFoZ and Zima as they feared losing business completely.

"I'm still charging $200 000 for cash patients as consultation fee," said a doctor operating in Mabvuku. "People can't afford these huge increases. Already there is resistance and I believe individual doctors are actually adjusting fees depending on their market -- class of patients and the area they live in."

General practitioners operating in high-density suburbs and downtown Harare were generally charging much less in comparison to the rates at private hospitals and institutions in the "hub of medical practice" -- the Avenues area, where there is a concentration of various specialists.

Ms Kazhanje said it was a question of supply and demand and not greed that forced some specialist doctors such as urologists, neurosurgeons, ophthalmologists (eye specialists) and others to charge higher fees.

"It's not greed at all, but market forces at play. What do you do when your services are in high demand? You increase the rates," she said.

However, she conceded that the flight of skilled medical professionals out of the country has had a serious impact on the quality of health service provided.

"Health is a strategic issue that should be given priority but, unfortunately, it's facing serious challenges. We would want to give as much, but we can't afford to pay the doctors," she said.

However, she said it was uplifting to note that a number of specialist doctors with "Zimbabwe at heart" were flying from as far as the United Kingdom, the United States, Botswana, South Africa and Australia to attend to patients at home.

Officials at other medical societies bemoaned that some doctors' demands were too high as to be unreasonable and unfeeling, citing instances of eye specialists who were demanding cash payment from patients for procedures that cost up to $60 million.

"We have problems with eye specialists, neurosurgeons and urologists who make absurd demands from patients needing urgent surgery," one official said. "They don't accept guarantee letters or cheques. They even wait for the cheque to be cleared before they attend to the patients. It's bad and this attitude must stop.

"These specialists must understand special situations and accept to help critical cases."

Some of the problems that medical aid beneficiaries grappled with included overcharging, self-referrals - doctors claiming money on reviews and minor ailments -- over-servicing and asking patients to pay cash upfront and subsequently claiming for full amounts from medical aid societies as well.

AHFoZ said the standard average contribution was $3,5 million per member and this was insufficient to cover all medical costs.

This, for instance, would only cover chest X-ray costs and co-payment, which now stands at $3,1 million.

"This accounts for the increase in the levels of shortfalls. Benefits now lag behind costs of services which account for the high level of shortfalls," said Ms Kazhanje.

Meanwhile, Health and Child Welfare Minister Dr David Parirenyatwa said he was not aware of the hike of medical fees.

He said he would discuss the issue with Zima and AHFoZ.

However, Dr Parirenyatwa emphasized the need to establish an independent statutory body that will scrutinise the operations of medical aid societies, Zima and charges made by individual medical practitioners.

"We want the inflation rate to decline, but this cannot be achieved when prices of goods and services continue to be increased," he said.

The minister said there was need for an independent statutory body that would scrutinise fees in the medical sector.