Healthcare not a luxury, but a necessity:PSMAS
This week’s PSMAS conversations column features PSMAS managing director, Dr Nixjoen Mapesa, outlining the Society’s mandate, its relationship with Premier Service Medical
Investments (PSMI) and strategies to open and sustain access for members. Health insurance has never been a luxury, but a necessity.
A necessity to guarantee access to healthcare providers when emergency health situations arise. As the largest and oldest medical aid society in Zimbabwe, Premier Service Medical Aid Society (PSMAS) is introducing this weekly column to interface with different stakeholders on medical aid in general, with emphasis on PSMAS.
The following questions come to the minds of many at the mention of PSMAS:
- Is PSMAS still operational?
Yes. PSMAS as a healthcare funder is very much operational.
To put things into context, let me begin by stating that PSMAS is a registered medical aid society wholly owned by its members.
The society uses the medical aid concept, which in essence is the pooling together of resources for the purpose of sharing healthcare costs.
With this in mind, PSMAS pools subscriptions from its members every month into a Fund.
Any member who falls sick during the course of the year is assisted through this Fund. There is a ceiling to one’s benefits based on the level of subscriptions on a particular product. In other words, the higher the subscription, the higher the benefit.
- What is the relationship between PSMAS and PSMI?
PSMAS established PSMI in the early 2000s in a bid to guarantee its members access to quality and affordable healthcare services. PSMI over the years grew into arguably the largest private healthcare provider in the country, with capacity to also serve members from other medical aid societies as well as the generality of the Zimbabwean population.
Along the journey, PSMI was given autonomy to run as an independent institution. This meant PSMI has its own Management and Board, separate from PSMAS, to run its affairs.
The current transactional relationship between PSMAS and PSMI is, therefore, that of healthcare funder and service provider.
This means that PSMI provides healthcare services to PSMAS members and submits claims for payment to PSMAS like any other service provider.
However, this is one area, the ongoing forensic audit looked into and the results and recommendations are expected to inform the PSMAS – PSMI relationship and business model going into the future.
- You said PSMI was formed to provide quality but affordable healthcare services to your members, one then wonders, where are your members getting service?
Premier Express Network is a multi-disciplinary network of healthcare service providers, which offers services to subscribing PSMAS members without or with minimal shortfalls.
The network consists of over 1000 providers, which include among others:
Primary healthcare facilities
General practitioners
Specialist practitioners
Hospitals – both private and public
Diagnostic services
Pharmacies
Dental practitioners
To ensure affordability, PSMAS negotiates with providers in this network to reduce or eliminate shortfalls thus ensuring healthcare services remain affordable to our members.
In the same vein, providers go through a quality check process to guarantee quality of services rendered to patients.
In a bid to bring healthcare closer to our members, providers enlisted on the Premier Express Network are distributed across all the geographical locations of the country.
- Why do members still incur shortfalls despite contributing every month?
In as much as we have a network of dedicated service providers, members still have a right to choose their preferred provider. In such instances, the service provider may charge a co-payment or shortfall.
Members can bring invoices from their service provider and PSMAS will pay for the invoice.
Allow me to put the issue of shortfalls into perspective. Members incur shortfalls not because of a specific medical aid company but because of inflation and fluctuations in the exchange rate.
In some instances, shortfalls arise because of the difference between a member’s subscriptions and that which the service provider charges.
In light of this, we encourage members, especially those living with chronic conditions, to upgrade to a higher plan so as to reduce shortfalls and enjoy more benefits.
- How do members get in touch with PSMAS?
PSMAS members can get in touch with us through our Contact Centre, which operates until 10pm daily. Our WhatsApp platform 0783 183 530 is also available for member enquiries.
Members can also email us on contactus@psmas.co.zw or via our Facebook page PSMAS Zimbabwe, Twitter handle @PSMASZim.
We also have our footprint across the country in towns such as Bulawayo, Gweru, Kwekwe, Gwanda, Hwange, Masvingo, Victoria Falls, Chiredzi, Chipinge, Mutare, Beitbridge, Rusape, Marondera, Bindura and Chinhoyi.
For any feedback, please email communications@psmas.co.zw-ebusinessweekly
