Adoption of managed care by medical aid societies in Zimbabwe

Abstract

Background: Globally healthcare costs have increased, and a significant proportion of this growth is attributable to moral hazard. Managed care tools are therefore widely used as healthcare cost containment strategies that attempt to moderate classical, provider and patient moral hazard. There is, however, no data on the extent of implementation of managed care tools by private health insurance organisations in Zimbabwe. Aim: We investigated the adoption of managed care tools by medical aid societies in Zimbabwe and explored their perceptions of how managed care tools have affected their healthcare expenditure. Methods: We used a cross-sectional study design and a sequential explanatory mixed method approach. Total population sampling was done for the quantitative component of this study, and six medical aid societies were purposively sampled for the qualitative component. Quantitative data were collected through a REDCap self-administered online survey and qualitative data were collected through online and telephonic in-depth interviews of medical aid society managers. The numerical data of the medical aid societies’ key operational factors were summarised using medians and inter-quartile ranges. Proportions of the adoption of manged care and the types of managed care tools implemented by medical aid societies were calculated. We also calculated the proportions of agreement by the medical aid societies managers to the factors affecting managed care tools adoption. A six-step inductive thematic analysis was used to analyse the qualitative data of the perspectives of medical aid societies on the effects of managed care tools on healthcare expenditure. Results: Our quantitative results show that 77.8% of medical aid societies have adopted managed care tools, with an average usage of 3.33±1.80 managed care tools. The adoption of specific managed care tools was 90.5% for preauthorisation, 57.1% for gatekeeping, 52.4% PPN, 42.9% capitation, 38.1% disease management, 28.6% discounted FFS and 23.8% for formulary by the study medical aid societies. Based on our qualitative data analysis, all the participants highlighted improved cost control as one of the effects of implementing managed care tools. iv Conclusion: Medical aid societies in Zimbabwe are adopting managed care tools into their operations. However, the use of some managed care tools is still low.