Medical tourism in Zimbabwe

1. Linda Mukusha (Mrs) Medical tourism in Zimbabwe

2. Presentation Outline • Definition of medical tourism • Zimbabwe healthcare delivery industry • Medical Funding Industry • Driver of Medical Tourism • Arrangements in place • Comparison of cost • Market views • Future of medical tourism

3. Definition of medical tourism • Medical tourism is when consumers elect to travel across international borders with the intention of receiving some form of medical treatment. • This treatment may span the full range of medical services, but most commonly includes dental care, cosmetic surgery for reconstructive purposes not aesthetic, elective surgery, and fertility treatment. (Neil Lunt, Richard Smith, Mark Exworthy, Stephen T. Green, Daniel Horsfall and Russell Mannion) Presenter logo to come here

4. Healthcare Delivery Industry • Population +13m • 70% Government Institutions • 30% Private Institutions • GP to patient ratio less than 1:300 (fuels fraud)

5. Declines in numbers of specialist (left the country during the 2007 – 2009 crisis)

6. Government institutions near collapse, old equipment • Private institutions catering for most treatments • MSA last revised in 2004, allows Minister of Health to set tariffs for service providers

7. Medical Funding Industry

8. Medical Funding Industry • 28 local medical funders, 1 SA player • Virtual / International players such as Bupa • 10% of population on medical cover • Tariffs negotiated at AHFoZ level not individual funder • Economy not performing well therefore affecting viability of funders • Post dollarisation (2009) balance sheets of most funders wiped out • Loss ratio +80% • Required to keep 3 months cover of subscriptions • Claims to be paid within 60 days • Medical funders entering the healthcare services as survival strategy • Size +/- US$300 million a year

9. Drivers of medical tourism in zimbabwe

10. Drivers • No preferred service provider networks where tariffs can be negotiated and agreed, Minister of Health will not allow this • No agreement on tariffs with service providers. Three different tariffs in the market, AHFoZ which most funders reimburse on, Association tariffs and ZIMA tariffs (bronze, silver and gold based on American model) • Sub-economic subscriptions in comparison to treatment costs • Minister of Health increased tariffs by 75% on GPs and about 5% across other disciplines (July 2014) • Service providers argue that medical inflation is at CPI +300%.

11. Drivers • Hospitals asking for +20% yearly • Service providers pass on capital costs to funders through exorbitant marks ups on services +100% to +500% • Lack of Specialist skills eg heart bypass surgery • Lack of Specialist equipment , private institutions affected, ie quality • Affordability on the part of the patient (benefit limit does not cover treatment costs in Zimbabwe) • High loss ratios suffered by medical funders

12. Arrangements in place for patients Drivers of medical tourism in zimbabwe

13. Embassies / Hospitals • Funders have arrangement with top 3 Hospitals in India • India Embassy facilitating treatments in that country by issuing visas on production of referral letter • Visas issued within 21days • No visas required for SA, Malawi and Zambia • Indian hospitals arranging packages that accommodate an accompanying spouse or relative • Total cost of treatment plus airfare and accommodation lower than Zimbabwe treatment

14. Brokers • Brokers in India entering into partnerships with Zimbabwean companies • Zimbabwean funders flooded with proposals from brokers • Patients have the option to use a broker or not • Not charging patients but remunerated by hospitals

15. Arrangements in place for patients Comparison of cost of treatment Drivers of medical tourism in zimbabwe

16. Source of Data • Medical Funders who are registered with Ahfoz • 2012 iFHP Comparative Price Report • Service providers • 86% survey response • 2012 and 2013 data collected • NB: Heart Bypass Surgery not available in Zimbabwe Figures could be a lot higher taking into account • +3 million Zimbabweans in South Africa • +500,000 in UK

17. Cataract 433% more expensive in Zimbabwe

18. Impact– Brain Tumor Excision

19. Impact– Hip Replacement

21. SA 18.4% decrease. India 103% increase. India cheaper than SA

22. *Organs refers to transplants, excisions and organ failures not otherwise specified Cardiovascular, cancers & musculoskeletal 85%

23. Musculosketal increase of 46%. Cancer decrease of 43%. Cardiovascular 38%

26. How has the market received medical tourism • PATIENTS: are happy they have choice and can get affordable treatment that preserves their benefit • FUNDERS: manage claims costs resulting in better financial performance • SERVICE PROVIDERS: want all treatments to be done in Zimbabwe except for treatment not available. Raise arguments for post treatment care and externalisation of funds • REGULATOR : their position not clear as no comment has been received from the office

27. Future of medical tourism in Zimbabwe • Until such a time as the healthcare delivery system has normalised, with service providers charging tariffs are in sync with the region, medical tourism will continue to grow • It is highly unlikely that there will be strong opposition from the government or regulator seeing that most government officials seek treatment outside the country

28. THANK YOU