Doctors 'forced' to demand co-payments
Standard rate unfair
MAN, like many other associations, was not consulted about the proposed adjustments in standard rates, which were accepted by administrators.
Doctors are currently being forced to either no longer perform any hospital procedures or require a substantial co-payment from patients."We are on the verge of insolvency given the latest iteration of administrators (of medical funds) where we do not get an annual increase, but also a significant and systematic decrease since 2021 for services and procedures carried out in the hospital in particular become," says Dr David Weber, chairman of the Medical Association of Namibia (MAN).
The Association for Namibian Medical Funds (Namaf) announced late last year that its current standard rates would not be increased.
According to Weber, the gap between fair compensation for services by a doctor and what Namaf (and by implication the administrators of medical funds) considers to be fair has grown to such an extent that it can currently be considered "unethical".
He referred to the operating costs of health practitioners which had skyrocketed in recent years and were mostly absorbed by practitioners.
However, MAN says that annual payments to hospitals - around 34% since 2018 of medical funds' expenses - are negotiated and compensation for the cost of medication and pharmacies (on average 17% of the annual expenditure) simply says the supervisory authority for financial institutions in Namibia (Namfisa's) annual report increased.
'Not consulted'
MAN, like many other associations, was not consulted about the proposed adjustments in standard rates, which were accepted by administrators, "but was unceremoniously informed during the Christmas season and via electronic mail".
Weber says a doctor dentist or any other allied health practitioner is strictly regulated by various statutory bodies including the Health Professions Council of Namibia (HPCNA), the Ministry of Finance and State Enterprises and the Namibian Medicines Control Council (NMRC).
Claims are also heavily policed to combat fraud, abuse and waste. Claims for general practitioners were just 9% and specialists just 11% of the total expenditure of medical funds, while non-related health expenditure – incurred in the quarter ending 30 June 2023 – amounted to N$135.7 million.
The latter is, according to Namfisa's quarterly statistics report for 2023, an increase of 3.2% on an annual basis and mostly to the administrators.
Weber says that it seems as if the milieu of the administration of funds seems to "focus exclusively on healthcare fraud" which according to MAN is present in all spheres of fiscal society. However, this is largely overshadowed by the "suspected yet unsubstantiated waste and/or rising costs incurred by facilities that have theatre lists, procedures or admission of patients".
However, according to MAN, the latter are not actively identified and chased by administrators of funds with such zeal.
Weber emphasised the association's support for the right of health practitioners to demand legitimate and fair compensation from patients, regardless of Namaf's standard rate which is "neither fair nor actuarially accurate".
He described doctors as the base of the health pyramid who are now being pushed aside due to misinformation, because they believe they are the reason for the current sustainability crisis of medical funds. – [email protected]