Original Article: https://neweralive.na/psemas-tariffs-reform-on-the-cards
Lahja Nashuuta
Government has pledged to review the outdated tariffs used to pay doctors under the Public Service Employees Medical Aid Scheme (PSEMAS), which still relies on rates set back in 2014.
PSEMAS is a government-subsidised medical aid scheme for public servants. According to government records, the scheme currently covers about 300 000 public servants and their families.
Responding to New Era queries, Ministry of Finance spokesperson Wilson Shikoto, admitted that the government is aware of the problems caused by the old tariffs and confirmed the matter is part of a broad reform process already underway.
“Government, through the PSEMAS Coordinating Committee, of which the Ministry of Finance is a member, is implementing short-, medium-, and long-term reforms as directed by Cabinet,” Shikoto said. “These reforms are aimed at addressing PSEMAS challenges in their entirety.”
Shikoto explained that contracted healthcare providers are reimbursed at 95% of the 2014 Namibia Association of Medical Aid Funds (NAMAF) rates, except for medical and dental specialists, who receive an extra 20%.
Cycling gear
He also confirmed that member contributions have not increased since the 2013/14 financial year, even though medical costs have steadily risen. “Contributions are also part of the ongoing reform process,” Shikoto added.
He denied allegations that private healthcare providers are leaving the scheme because it is unsustainable. “Our records indicate that the number of contracted healthcare providers has actually increased in recent years,” he said, stressing that participation is voluntary.
Private doctors feeling the pinch
But Namibia Private Practitioners Forum (NPPF) chairperson Dr Jürgen Hoffmann paints a different picture. He said outdated tariffs are forcing many private doctors either to leave PSEMAS or to charge patients extra to cover the shortfall – a cost many patients cannot afford.
“In 2020, about 93% of private doctors worked with PSEMAS. By the end of 2024, that number dropped to 75.6%. If nothing changes, less than 60% will still be contracted by the end of 2025, especially in rural areas,” Hoffmann warned.
He explained that PSEMAS is still using the 2014 NAMAF benchmark, which has not been updated for more than a decade. Other medical aids already use the 2025 NAMAF tariff, which is almost double the old rate.
Cycling gear
“Specialists under PSEMAS get 20% above the 2014 rate, but general practitioners and other healthcare providers are still paid exactly what they were paid 11 years ago,” Hoffmann said.
He stressed that doctors contracted with PSEMAS are legally bound to accept these outdated rates and are not allowed to charge patients more, even though running a practice has become far more expensive.
“Many have now stopped renewing their contracts, forcing PSEMAS members to pay cash upfront and then claim reimbursement themselves – a process some find slow and frustrating,” he said.
Patients turned away
Some members have already felt the effects. One PSEMAS beneficiary who spoke on condition of anonymity said: “The doctor told me he no longer accepts PSEMAS because the rates are too low. If I wanted treatment, I’d have to pay cash.”
Another woman recounted being turned away at a clinic. “The receptionist said they don’t take PSEMAS anymore. I was told to either pay out of pocket or find another facility,” she said.
Hoffmann claimed other medical aids that use the NAMAF benchmark update their tariffs every year. “If the benchmark says a service costs N$40, the medical aid pays N$40, and the patient pays nothing extra,” he explained.
In contrast, PSEMAS has not adjusted its rates since 2014, despite rising inflation, salary changes, and increased medical costs. Hospital benefits have also dropped by 33% since 2022, meaning patients now pay more from their own pockets when admitted.
Hoffmann said NPPF has been engaging with the government for years without progress. “We’re not asking for luxuries, just fairness. We want the government to update tariffs to reflect the real cost of healthcare in 2025,” he stressed.
The forum has warned that unless the government acts quickly, PSEMAS could collapse by 2027. On behalf of NPPF, Hoffmann proposed the creation of a Medical Control Board to set tariffs, monitor services and prevent abuse.
“Government can still save PSEMAS, but only if it acts quickly and seriously,” Hoffmann urged.
-lnashuuta@nepc.com.na
Read more: PSEMAS tariffs reform on the cards https://neweralive.na/psemas-tariffs-reform-on-the-cards
