Namibia needs to rethink the current operations of the medical health industry and the general provision of health services, whose shortcomings have been brought to the fore in recent months,
CEO of the Namibian Association of Medical Aid Funds (NAMAF), Stephen Tjiuoro said in an interview this week.
NAMAF is a juristic body established to control, promote, encourage and co-ordinate the establishment, development and functioning of Medical Aid Funds in Namibia.
South Africa, which has a similar medical aid concept like Namibia, has come up with a number of regulations to best serve the public especially those who pay membership contributions.
Tjiuoro said in South Africa, the government has told the industry that certain medical conditions cannot be excluded for coverage or members running out of benefits before the end of the year.
“So it is the business of the medical aid funds to restructure, cater for what they prescribe as minimum benefits, so that the minimum benefits cannot run out. The minimum benefits cannot be excluded,” he said.
The NAMAF CEO added that in the past they have not taken a proactive role in reforming the industry because they were focusing on registering doctors, working on benchmark tariffs for doctors and making sure that the funds were operating sustainably.
“It’s up to the government to say how the funds should operate because NAMAF was established under the Medical Aid Funds Act of 1995.”
Tjiuoro said the private medical aid funds pay N$4 billion per annum for medical services, but only caters for eight percent of the Namibian population.
In contrast, the Public Service Employees Medical Aid Scheme (PSEMAS) pays about N$2.5 billion per annum in medical benefits, but caters for 10 percent of the population.
With 65 percent of the N$6.5 billion budget for the health ministry going for operations and expenses, 82 percent of the Namibian population rely on the remaining N$2.3 billion of the ministry’s budget.
“This is how the table looks. We are not rethinking our policies, more so in terms of Vision 2030. This is the kind of data we can use to influence policy changes.”
Tjiuoro’s comments come as government is in the process of establishing Universal Health Coverage in the country.
“Maybe the government has been too hands-off in terms of the happenings in the medical aid funds industry, forgetting that the industry operates based on the Medical Aid Act. If the Act is not working, the government can always change it.”
With the economy facing a down turn in the past two years, NAMAF has seen principal members drop from 94,048 in August 2017 to 89,264 in March this year.
“It appears there is a decrease in membership of chronically ill people and elderly persons. Those are high risk members. As part of cross subsidisation, you would have young and healthy people who do not claim frequently. For a fund to maintain a healthy balance you would rather want to have a lot of healthier younger people and your claim profile will not take up all the money.”
Tjiuoro said NAMAF has not established whether the decrease is due to deaths or the elderly opting out of medical schemes because they cannot afford premiums.
“It could because of tariff increases or the economic down turn, but there is a decrease for the first time in 10 years.”