The Namibia Private Practitioners Forum (NPPF), a voluntary professional body representing some 200 medical practices, says that medical cover has been eroded steadily despite hefty increases introduced by all private medical aid funds.
Dr Jürgen Hoffmann, Chief Executive of the Namibia Private Practitioners Forum.
The forum’s Chief Executive, Dr Jürgen Hoffmann pointed out that member contribution was increased a whisker short of 10% last year but the NAMAF benchmark tariff remained static and hospital benefits reduced by one third.
The offset is that medical aid funds posted substantial increases in reserves. Open funds’ reserves grew to 33.8% of total contribution income while closed funds now boast reserves at 66.5%.
According to Dr Hoffmann, this points to skewed priorities in financial risk management in the sense that patients have to pay more for less cover while the funds grew their reserves above the statutory limit of 25%.
“Reserves are growing while patients shoulder higher costs and reduced cover. The system is shifting costs onto the sick and not improving their care. Patients are financing fund surpluses rather than medical services,” he stated.
Eroding Benefits and New Risks:
Hoffmann said NAMAF is pushing on behalf of medical aid funds for the continued use of ICD-10 codes even though Namibia and the rest of the world have transitioned to ICD-11.
“These codes reveal a patient’s diagnosis to medical aid funds and their administrators. NAMAF claims that Section 10 of the Medical Aid Fund Act, read together with Regulations 5 and 6, gives them authority to enforce ICD-10 as a tool for administration and cost retention.”
What drove the spike in medical services after Covid 19?
“The NPPF underscored several post-pandemic drivers of higher healthcare utilisation that were foreseeable by 2023, yet largely ignored in NAMAF’s policy decisions,” said Hoffmann.
These include elective procedures that were postponed during the pandemic, a trend observed globally and confirmed by the Altarum Health Sector Indicators and the WTW Global Medical Trends survey.
Also, a massive increase in the number of registered medical practitioners without a transparent, evidence-based assessment of fund sustainability, had a serious impact on medical aid funds. Since 2020, NAMAF has approved and registered more than 800 new applications by medical and ancillary practitioners which added enormously to the burden carried by medical aid funds.
“Patients deserve answers. They were unjustly accused of overutilisation in 2023, yet are now paying more for less. Regulators must ensure that contribution increases and benefit cuts are backed by evidence,” concluded Dr Hoffmann.
Original Link: https://economist.com.na/100041/health/private-practitioners-target-medical-aid-funds-higher-contributions-less-cover/
