• Health

Medical premiums, services more expensive - again

• 1 Week Ago - 2024-12-09 10:05:00

Should the Namibian Medical Aid Association (NAMAF) decide for the second consecutive year not to increase the standard rates for next year, approximately 66% of private health practitioners in Namibia still plan to increase their rates.
In December 2023, NAMAF announced that standard rates would remain unchanged until at least the end of the first quarter of 2024 – and possibly longer. The result was that members of private medical aid funds suddenly had to pay significant co-payments from their own pockets for everything from hospitals to anaesthetists. The decision, which was taken without any consultation with medical aid members or service providers, according to the Namibian Private Practitioners Forum (NPPF), is essentially a reduction in members’ benefits because funds will not compensate members for medical inflation.
Then, private medical funds increased members’ contributions by an average of 10% with the approval of the Namibia Financial Institutions Supervisory Authority (Namfisa), after some funds requested up to 15%. Several medical funds have already told their members that their monthly contributions for next year will increase by between 3% and 5%.
NAMAF's defence was that cost trends and the resulting impact on the financial sustainability of funds with the increase in tariffs would be irresponsible without considering various interventions or strategies. Also, these strategies are complex to develop and implement and a gradual approach is needed. A decision was therefore taken that tariffs for this year would remain unchanged until management strategies were implemented to ensure the sustainability of an industry that ranges from service provision to financing.
Standard rates
According to a recent NPPF survey of private health practitioners ranging from doctors to medical specialists and optometrists, the forum was informed that standard rates for next year will increase by between 4.6% and 4.9% for different disciplines. The NPPF says that according to their survey, 7% of respondents charge significantly more than the standard rates, 27% slightly more, while 60% charge the standard rates for their services. According to 62% of respondents, the financial impact of NAMAF's decision not to increase the 2024 standard rates was huge.
The NPPF says it is therefore essential to study the impact of the downward pressure on practitioners because the key question is “for how long can the private health industry absorb the cost-saving strategy through the funds, until the industry becomes unsustainable?"
“Namibia is home to a world-class private health industry. It has taken decades of investment, development and capacity building to reach this point. Once it is destroyed, it will take decades to bring private healthcare back to its current level,” the NPPF said.
The majority of respondents (77%) also agreed that Namfisa’s inaction has had a “negative impact on the effective regulation of medical funds and leaves members and service providers without any defence against the actions of funds”.
Referring to the ICD-10 coding system that private practitioners are now forced to use or their claims will not be processed, the majority agreed that the system will not effectively curb fraud and abuse.
The Health Professions Council of Namibia (HPCNA) also recently announced an increase in its tariffs, including annual legal fees. According to the new fees, service providers who are not Namibian citizens will have to pay significantly more than Namibian citizens, even in cases where the practitioners have been practising in the country for years.
According to the NPPF survey, almost 60% of respondents are willing to contribute financially to a legal action that challenges the inequality in fees.