Our maid took ill last week so I asked Clive Field, who is in the medical aid world, to give me an email about Medical aid for domestics and this is what he sent me today.
From: Clive Field firstname.lastname@example.org
Medical Aid for Domestics?
Having the ability to employ domestics in our homes and gardens is undeniably one of the many “pluses” of living in Zimbabwe.
Whether or not to provide health care for domestics is however a thorny question: there is no statutory requirement, but any decent employer will wonder about the de facto need to provide some level of medical cover for his domestic so that in the event they become ill, they will have the ability to access medical treatment quickly and without it immediately becoming the employer’s responsibility to pay for it.
Looking quickly at some numbers: a private GP in Zimbabwe currently charges around $50 per consultation, and all other medical service providers base their charges on that. It is immediately apparent that this is a lot for a domestic worker to afford…and if you consider further that (according to current data), the average usage of GP’s is at 2 visits per person per year, and that medication is routinely prescribed by a GP at each visit (adding to the consultation cost), then you can quickly arrive at a total annual cost of over $100, which is about 10% of a domestic worker’s annual income!
So, what can you as an employer do about providing health care for your domestic?
In general, the answer really depends on how much you as an employer are willing to spend.
If you decide you will bear ALL of the medical costs (including private health care), for your domestic that is laudable but in reality it will not spare you any costs. Why not? Because you as an employer will be liable for monthly contributions to the Medical aid PLUS any treatment shortfalls your domestic incurs – being the difference between the tariff stipulated by AHFoZ for the procedure (eg GP visit: AHFOZ tariff Us 25, actual cost Us 50 = shortfall Us 25 – funded by the patient)
Under this scenario, it all ends up being your expense in the end. Thus, the only real advantages of paying monthly subscriptions for your domestic to belong to a medical aid are:
- the cash flow impact of the medical event will be ‘lessened’ – via cost sharing between the medical aid fund (paying up to tariff) and the employer (paying shortfalls);
- convenience – your domestic can take himself directly to be treated at facilities accepting medical aid without needing to come first to you to ask for cash – especially useful if he is not at work when he falls ill.
There is another approach – you could offer to cover ONLY the cost of medical aid membership for your domestic – making it his responsibility to meet the cost of any shortfalls. All well and good, but if he incurs a significant shortfall then in all likelihood this will come back to bite you when he cannot meet it, because he will come to you asking you to fund it. So you arrive back in the same place as the employer above, paying for everything.
Medical Aid options?
There are a number of medical aids offering what we might describe as ‘entry level’ membership, with subscriptions currently costing between Us 20 and 40 a month. So, not cheap by any means!
Statistics obtained from the better medical aid societies show that it is not possible to offer entry level Medical aid cover much cheaper than this, unless benefit awards are ‘capped’ at lower limits, for example capping awards at say 50% of the AHFoZ tariff. However, larger shortfalls would then become inevitable – but at least the medical aid fund would be making some contribution towards cost. The medical aid could award a GP consult at a rate of $13, (i.e ½ the AHFOZ tariff) and the employer or member would then chip in the balance of $8 to $35, depending on what the GP actually charged.
One problem with entry level medical aid schemes is that their benefits will certainly not provide much (or any?) benefits for members who need to use expensive private facilities like the Trauma Centre, instead of local government clinics.
The health care system in Zimbabwe comprises different players at different levels, geared to different income bands and expectations. There are really 3 options:
Mission hospitals – some of which provide excellent surgery at low cost, but the service experience itself will usually be distinctly ‘third world’;
The Government system – generally cheap, but inconsistent in terms of quality of care and outcome, with minimal investment in the customer service experience;
The private healthcare system – both expensive and inconsistent, but where a lot more investment has been made into customer service and facilities that look and feel good to users.
Knitting something together that provides the most cost-effective utilisation of all 3 systems would be a difficult and expensive project. However it would probably yield good healthcare at an affordable cost. Unfortunately, at present there don’t seem to be any healthcare funders wanting to take on that headache, in terms of heavy up-front investment.
So, in summary, although a low cost medical aid is a great idea – because it would serve not only domestic workers and low income employees, but also the informal market of self-employed vendors and dealers – the cost of setting it up would be significant and no-one is coming forward to do it. This vacuum is unlikely to be plugged any time soon by Govt’s own much-publicised plans to launch a national health service, IF that ever sees the light of day.
Should this change, we will let you know.
What to do?
If you as an employer calculate the cost of funding health care (medical aid contributions) for your domestic over a 12 month period, you will arrive a figure of not less than Us 180 per domestic per year, rising to Us 400 + , depending on the Medical Aid Society and scheme you opt for. The ‘once-off’ cost of treatment for an acute condition or episode is very likely to be less than this figure.
As a result, the ‘self funding’ approach (currently very much the norm among employers ) is often where you arrive. Not ideal, we admit, but an added benefit of self-funding is that it will save employers the extra paperwork and admin involved in dealing with medical aid depts. who (let’s be honest), are not always on top of their game in handling membership queries and claims!
Clive Field – Director
MedAid Medical Agencies
44 Princess Drive, Newlands, Harare
Office: +263-4-746 257 Mobile: +263-772-331 529