In recent months, the debate around tariffs and co-payments has intensified, with medical funds leaning heavily on outdated benchmark structure to justify reduced reimbursements. This has left practitioners underpaid, patients confused about co-payments, and the sustainability of private healthcare increasingly at risk. At the heart of the issue is the difference between coding—a language for billing—and pricing, which should be based on real costs.
The Problem with NAMAF’s Benchmark
NPPF’s position is not to dismantle coding as a communication tool, but rather to challenge NAMAF’s unlawful and outdated use of the 2003 benchmark as a de facto tariff-setting mechanism. While coding is an essential “common language” for billing and claims processing, the problem arises when this system is manipulated to impose tariffs that no longer reflect economic realities or the cost of delivering healthcare.
How Funds Generated Surpluses
For many years, higher private fees (such as the AHB rate of 225%NAMAF) compensated for the shortfall created by NAMAF’s benchmark. However, when funds reduced the AHB to 150% without adjusting the underlying tariffs to match real practice costs, they generated massive surpluses—N$229.7 million during the first quarter of 2025 alone. This was not due to better efficiency, but due to systematic underpayment for professional services. Such practices are unsustainable and threaten the quality and availability of healthcare in Namibia.
Why the Cost Study Matters
The Namibian Private Practitioners Forum (NPPF) supports a healthcare model where coding and pricing are responsibly separated. Coding remains a clinical and administrative standard, while tariffs are established transparently through independent cost studies.
The ongoing Healthman cost study is central to this reform, aiming to create a fair, evidence-based benchmark tailored to Namibian healthcare realities.
This benchmark will:
Reflect the actual cost of delivering quality healthcare in Namibia.
Align with global best practices, where fees are set by providers rather than unregulated funders or administrators.
Promote transparency by making tariff data accessible to patients, practitioners, and funders—instead of restricting it behind digital firewalls.
The Way Forward
For this reform to succeed, we need the support and participation of practitioners across all disciplines. The more data we have, the stronger our case becomes for fair tariffs that ensure both provider sustainability and patient access to care.
Dr Jürgen Hoffmann
CEO: NAMIBIA PRIVATE PRACTITIONERS FORUM
Cell: 081 1242884
Email: ceo@nppf.info
