Late payments, low tariffs and lots of red tape put private healthcare providers off from treating government employees
Even after the 100% increase in member contributions to the Public Service Employees Medical Aid Scheme (PSEMAS), a group of healthcare practitioners styling themselves as the Namibia Private Practitioners’ Forum, argues that taxpayers will still have to foot about two thirds of the scheme’s expenses.
The Namibia Private Practitioners’ Forum is a non-profit organisation whose members are all healthcare providers in private practice of all healthcare disciplines.
Calling all talk about PSEMAS sustainability a misnomer, the private practitioners pointed out that PSEMAS is not a conventional medical aid. It does not provide cover only to the total of all contributions, it provides cover regardless and this happens to the detriment of Namibian taxpayers.
However, a much bigger threat, comes from healthcare providers themselves. Listing a number of impediments, the Forum said medical professionals have become wary of PSEMAS. The administrative processes are cumbersome, payment is late and not always guaranteed, and the levels of compensation are vastly inadequate.
“As PSEMAS continues to expose private healthcare providers to financial risk, low tariffs and deplorable inefficiency in renewal of contracts, access to private healthcare services to PSEMAS patients will decline sharply,” according to the Forum.
Corroborating this allegation, the Ministry of Finance said in a notice dated 23 April 2019 that it is still in the process of reviewing the current PSEMAS contract for healthcare service providers, which came into effect at the beginning of May last year. The ministry expects this process to last until the end of March next year, 2020, therefore it requested healthcare service providers to extend the contract for another eleven months.
On the contractual relationship, the Private Practitioners Forum said “PSEMAS does not pay a healthcare provider who is not contracted with PSEMAS. PSEMAS has in the past refused payment to healthcare providers who, bona fide, treated PSEMAS patients while waiting for PSEMAS to confirm contract renewals.”
In a Forum survey sent to over one thousand service providers, more than 80% of the 361 respondents indicated that it is not financially viable for them to treat government employees.
A large majority of the respondents felt that they are exposed to substantial financial and sustainability risk with a very significant group fearing that PSEMAS may completely default on payment at some point in the future.
Explaining the financial cost of late payments, the Forum stated “As healthcare providers purchase medical supplies they use for, and medicines they provide to PSEMAS patients, which supplies and medicines must be paid by the healthcare provider within 30 days of purchase, healthcare providers are effective bankrolling PSEMAS from their own pockets.”
On the inadequate PSEMAS tariff structure, the Forum said “PSEMAS currently pays N$281,39 per standard consultation with a General Practitioner. The South African Government Employees Medical Scheme (GEMS) pays 32% more than PSEMAS, at R370,90 per consultation.”
As a comparison, doctors working for the government earn roughly 40% more than private practitioners, while the former are not exposed to the financial risk of the latter. This, the Forum said, is according to a cost study done in 2014 by the consulting firm, Healthman, adjusted for inflation.
Namibian private medical aid funds following the 2019 NAMAF Benchmark Tariffs pay 46% more than PSEMAS, at N$411,20 per consultation.
“As PSEMAS is concerned with ‘sustainability’ on the cost side, which is almost solely dependent on a healthy free market economy in any event, PSEMAS fails to observe and act on the real risk it faces on the supply side,” the Forum stated while warning that government employees face the risk of becoming second-rate patients as healthcare service providers try to reduce their exposure to PSEMAS.