Insured persons are asked to pay twice
Despite increasing contributions, health insurance companies are once again maintaining their unchanged service rates for the medical sector. However, the sector cannot survive without corresponding rate increases for its services and will therefore have to raise rates. Since the health insurance companies are not compensating for this cost difference, the members themselves will have to cover it.
Henriette Lamprecht
11 DECEMBER 2024 - 2024-12-11
By Henriette Lamprecht
(Edited by F. Steffen)
Windhoek
Should the Namibian Association of Medical Aid Funds (NAMAF) decide for the second year in a row not to increase standard rates for the coming year, approximately 66% of private healthcare providers in Namibia plan to increase their rates anyway.
NAMAF announced in December 2023 that standard rates for services covered by health insurance funds would remain unchanged until at least the end of the first quarter of 2024 – possibly longer. This resulted in members of private health insurance plans suddenly having to make significant out-of-pocket payments, whether for hospital stays or anesthesiologists. According to the Namibian Private Practitioners Forum (NPPF), the decision was made without consulting either the insured or the service providers.
Inflation is ignored .
Ultimately, this means a reduction in services, as health insurance funds do not compensate their members for medical services that have become more expensive due to inflation. At the same time, with the approval of the Namibian Financial Services Authority (Namfisa), private health insurers increased member premiums by an average of 10 percent, with some funds requesting increases of up to 15 percent. Several health insurers have already informed their members that their monthly premiums for the coming year will now increase by a further 3 to 5 percent.
NAMAF justified the decision by arguing that, given cost trends and the resulting impact on the funds' financial sustainability, a tariff increase would be irresponsible without first considering various interventions or strategies. However, these strategies are complex to develop and implement and require a phased approach. Therefore, it was decided to leave the tariffs unchanged for this year until management strategies to ensure the sustainability of the industry—from service delivery to financing—are implemented.
34% of rates already higher
According to a recent NPPF survey of private healthcare providers—including doctors, medical professionals, and opticians—the forum was informed that standard rates for the coming year are expected to increase by between 4.6% and 4.9%, depending on the discipline. The survey revealed that i) seven percent of respondents charge significantly higher rates than standard rates, ii) 27% charge somewhat more, and iii) 60% of medical providers charge standard rates for their services. 62% of respondents indicated that the financial burden of NAMAF's decision not to increase rates for 2024 was significant.
The NPPF emphasized the need to investigate the impact of cost pressures on practitioners, as the key question is: "How long can the private healthcare industry absorb the funds' cost-saving strategies before the industry itself becomes unsustainable?"
"Namibia has a world-class private sector healthcare industry. It has taken decades of investment, development, and capacity building to reach this point. If this infrastructure is destroyed, it will take decades to restore this industry to its current level," the NPPF stated.
Namfisa Fails in Its Duty
The majority of respondents (77%) also agreed that the lack of action by Namfisa "has extremely negative implications for the effective regulation of medical funds, leaving both members and service providers vulnerable to the actions of the funds."
Regarding the ICD-10 coding system, which private practitioners are now forced to use or their claims will not be processed, most respondents felt the system will not effectively curb fraud and abuse. The Health Professions Council of Namibia (HPCNA) also recently announced an increase in its fees, including annual registration fees. According to the new fees, providers who are not Namibian citizens will have to pay significantly more than Namibian citizens, even if they have been practicing in the country for years.
According to the aforementioned NPPF survey, almost 60% of respondents are now willing to contribute financially to a lawsuit against this HPCNA decision, thereby challenging this fee inequality.
Original article: https://www.az.com.na/gesundheit/krankenkassen-treiben-reibach2024-12-11
