Cimas Past, Present & Future

1. CimasPast, Present & Future

2. Formation & Ownership • Been in business since 1945 • Brainchild of Mashonaland Chamber of Commerce • Society is owned by members and employers • Employers play critical role: • - facilitation of contribution payments • - information conduit between Cimas & members • Many employers used to pay 100%

3. Objects of the Society • Establish a fund/funds to finance wholly or in part the medical, dental and allied requirements of its members. • To operate, manage or administer any service, body or institution which is conducive to the provision of health care facilities.

4. Cimas Board • Composition defined in section 5 of the constitution comprising the following: • 4 Employer representatives • 4 Member representative • 4 Appointed members but shall retire at the next but one AGM. • 1 CEO appointed by the Board.

5. Operations (Membership

6. Operations Cont….(Financials) – Balance Sheet as at Nov 2003 Assets $000’s Non-current assets - $ 2,444,728 Long-term investments - 4,052,647 Current assets - 32,195,100 38,692,475 ======== Reserves and Liabilities Brought Forward - $ 9,157,325 Revaluation Surplus - 100,680 Current Year Surplus - 9,457,397 Current Liabilities - 19,977,073 38,692,475 ========

7. Group Revenue July – November 2003 Medical Aid ‘000’ Contribution Revenue - 20,988,326 Claims Paid - (15,787,519) Overheads - ( 2,988,774) Surplus - 2,212,033 ========= Chronic Diseases Add-on 189,104 Medical Services 181,495 Properties 9,357 Investment Income 6,941,867 Group Surplus 9,533,857 ======= roup Revenue July – November 2003

8. Claims – Pie Chart

9. Human Resources Employees Medical Aid Business = 270 Medical Laboratories = 134 Total = 404 === Note: 65% are skilled personnel

10. Cimas as a Health Service Provider • Cimas Laboratories • Harare Haemodialysis • Centre of Excellence • Medical Centre – Bulawayo • Medical Chambers – Harare • Other Areas of Participation • Diagnostic Imaging (First MRI) • Montague Clinic Eye Unit (NAMAS initiative)

11. Cimas Brand • Cimas is a strong brand • Has international reputation • International competitors have sought joint ventures

12. Relationship with Service Provider • Good relationship with most providers • Has built provider networks for managed care products. • Fee for service environment creates adversarial relationships with providers. • Medical advisors • - 4 in various disciplines • - 1 Chief Medical Officer

13. Environment • Hyperinflation • Mutual Societies are demutualising • Mechanism for stakeholder rights execution and enjoyment – being questioned. • Philathropic view is now being questioned • The Young not keen to subsidise the old • Healthcare has become a significant cost to employers and employees • Current corporate governance thrust require organisational structure reviews • Employees sharing contribution costs now demand choice of medical aid plan. • Hostile to managed care initiative. • International competition. • International experience in funder/provider relations.

14. ZiMA /NAMAS Impasse • Practice has been on agreement once per year on tariff of fees. • Impasses a feature of Fee For Service environment. • Current status…..

15. What Some Stakeholders are saying • Want affordable quality healthcare • Object to paying cash up-front. • Object to co-payments. • Feel that contribution levels are unaffordable. • Want improved turn-around time of claims. • Some desire a stake in the business. • Expect Cimas to be involved more in healthcare provision to ensure availability of services. • Some suggest introduction of savings options, no-claim bonus. • Worry about skills flight in the health sector

16. The Way Forward… • Cimas has a number of things that need to be done to address these issues. • What are your views? • THANK YOU