|The Business Response to HIV/AIDS: Innovation & Partnership (UNAIDS, 1997, 60 p.)|
|Examples of Company Actions on HIV/AIDS|
A. THE COMPANY
CIMAS is a private insurance company offering health insurance in Zimbabwe. It has approximately 45% of the country's health insurance business, generally providing for people with financial means or with insurance through their employment.
B. REASONS FOR ACTION ON HIV/AIDS
Although HIV was thought to have entered Zimbabwe in the late 1970s, the first case was not officially identified until 1985. By 1995, around 65,000 cases had been identified, with the Ministry of Health anticipating approximately 900,000 of the country's population of approximately 11.5 million to be HIV-positive by the end of 1997.
By November 1994, CIMAS estimated that of its 317,000 beneficiaries, approximately 27,000, or about 8.5%, were HIV-positive. Most of them were not yet making HIV-related claims, and had not necessarily been tested for HIV. The average cost of treatment for an AIDS patient was around Z$ 4,200 (US$ 420) per year, accounting for approximately 4.8% of the company's claims costs. CIMAS was anticipating dramatic rises in both numbers infected and treatment cost.
C. EXAMPLE ACTIONS
To remain in business profitably with the projected increase in costs, CIMAS has had to review its policies. The changes made, and areas explored to date, include the following:
Policy Changes in Effect
· Increased premiums. CIMAS has attempted to limit the increments to levels people can afford, and has also widened its range of policies to meet the needs of different sectors of the population. Despite these measures, HIV/AIDS is impacting the cost of policies.
· Promotion of home nursing instead of hospitalisation. CIMAS is willing to pay full costs for 24-hour-a-day nursing at home, which is far cheaper than meeting hospital costs and is preferable for the patient and family. A large proportion of costs for many AIDS patients are sustained in the last few months of life.
· Reduction in doctors' visits. Such visits form the largest budget item for AIDS patients and yet often achieve little health benefit.
Policy Changes Under Consideration
· Introduction of a ceiling on claims for particular conditions or types of benefit. This could be a ceiling per medical complaint per annum and/or a ceiling per number of hospital days or drug payments.
· An exclusion clause exists based on age but not on existing illnesses. However, the constitution allows CIMAS to cease payments for an individual member for a particular condition if expenditures become excessive. This clause is reportedly rarely invoked, but could be in individual cases.
· Advocacy for a treatment protocol that reduces unnecessary expenditures. South Africa has developed such a protocol, but this has not yet been applied in Zimbabwe.
· Financing of generic drugs only for treatment. The national drug policy would need to endorse a generic drug code to make this practicable.
CIMAS considers it unethical to discriminate against AIDS patients, as the ethic of health insurance is to provide cover when people need it. It will not charge increased premiums for people with HIV, nor will it endorse a policy of screening except where individual testing is needed for medical treatment. With a combination of the above policies still to be refined, CIMAS is reasonably confident that it will be able to meet the escalating costs of AIDS-related claims. The company is also strongly supporting preventive campaigns and measures in the community.
Contact: Helen Jackson
Executive Director, Southern Africa AIDS Information Dissemination Service
PO Box A509, Harare
Tel: 263 4 336193/4
Fax: 263 4 336195
Note: Most of the information in this case study is from a paper "Mitigating the Impact of AIDS at the Workplace: A Discussion With Primary Focus on Business Experience in Zimbabwe", presented by Helen Jackson of the Southern Africa AIDS Information Dissemination Service to the 4th National Seminar on AIDS, in Accra, Ghana, in November 1994.