Medical premiums, service prices hiked – again
If the Namibian Association of Medical Aid Funds (Namaf) decides not to increase the standard tariffs for a second consecutive year, around 66% of private healthcare practitioners in Namibia still plan to raise their rates.
Namaf announced in December 2023 that the standard tariffs would remain unchanged until at least the end of the first quarter of 2024 – and possibly longer.
As a result, members of private medical funds were suddenly subjected to significant out-of-pocket contributions for services ranging from hospitals to anaesthetists.
According to the Namibia Private Practitioners' Forum (NPPF), the decision, which was made without consultation with medical fund members or service providers, essentially represents a reduction in members' benefits because funds will not compensate members for medical inflation.
Subsequently, private medical funds increased members' contributions by an average of 10%, with approval from the Namibia Financial Institutions Supervisory Authority (Namfisa), after some funds requested increases of up to 15%.
Complex
Several medical funds have already informed their members that their monthly contributions will rise by between 3% and 5% for the upcoming year.
Namaf's defence was that cost increases and the resulting impact on the financial sustainability of funds would be irresponsible without considering various interventions or strategies.
Additionally, these strategies are complex to develop and implement, and a gradual approach is needed, it argued.
Consequently, it was decided that tariffs would remain unchanged for this year until management strategies are implemented to ensure the sustainability of an industry that encompasses both service provision and financing.
No recourse to action
According to a recent NPPF survey among private healthcare practitioners, including doctors, medical specialists and ophthalmologists, the forum was informed that standard tariffs for next year will increase by between 4.6% and 4.9% across different disciplines.
The NPPF stated that, according to their survey, 7% of respondents are requesting significantly higher rates than the standard tariffs, 27% are asking for slightly more, while 60% are requesting the standard tariffs for their services.
According to 62% of respondents, the financial impact of Namaf’s decision not to increase the standard tariffs for 2024 was significant.
The NPPF noted that it is therefore essential to study the effects of the downward pressure on practitioners, as the key question is: “For how long can the private healthcare industry absorb the cost-saving strategies of the funds before the industry becomes unsustainable?"
The forum also warned: "Namibia is home to a world-class private healthcare industry. It has taken decades of investment, development and capacity building to reach this point. The moment it is destroyed, it will take decades to bring private healthcare back to its current level."
The majority of respondents (77%) also agreed that Namfisa's lack of action has had an "extremely negative impact on the effective regulation of medical funds, leaving members and service providers without any recourse against the actions of the funds."
Legal action considered
Referring to the ICD-10 coding system that private practitioners are now forced to use or risk having their claims not processed, the majority agreed that the system will not effectively tackle fraud and abuse.
The Health Professions Council of Namibia (HPCNA) recently also announced an increase in its fees, including annual registration fees.
According to the new fees, service providers who are not Namibian citizens must pay significantly more than Namibian citizens, even in cases where practitioners have been practicing in the country for years. According to the NPPF survey, nearly 60% of respondents are willing to financially contribute to a legal action challenging the inequality in the fees.
– [email protected]
Namaf announced in December 2023 that the standard tariffs would remain unchanged until at least the end of the first quarter of 2024 – and possibly longer.
As a result, members of private medical funds were suddenly subjected to significant out-of-pocket contributions for services ranging from hospitals to anaesthetists.
According to the Namibia Private Practitioners' Forum (NPPF), the decision, which was made without consultation with medical fund members or service providers, essentially represents a reduction in members' benefits because funds will not compensate members for medical inflation.
Subsequently, private medical funds increased members' contributions by an average of 10%, with approval from the Namibia Financial Institutions Supervisory Authority (Namfisa), after some funds requested increases of up to 15%.
Complex
Several medical funds have already informed their members that their monthly contributions will rise by between 3% and 5% for the upcoming year.
Namaf's defence was that cost increases and the resulting impact on the financial sustainability of funds would be irresponsible without considering various interventions or strategies.
Additionally, these strategies are complex to develop and implement, and a gradual approach is needed, it argued.
Consequently, it was decided that tariffs would remain unchanged for this year until management strategies are implemented to ensure the sustainability of an industry that encompasses both service provision and financing.
No recourse to action
According to a recent NPPF survey among private healthcare practitioners, including doctors, medical specialists and ophthalmologists, the forum was informed that standard tariffs for next year will increase by between 4.6% and 4.9% across different disciplines.
The NPPF stated that, according to their survey, 7% of respondents are requesting significantly higher rates than the standard tariffs, 27% are asking for slightly more, while 60% are requesting the standard tariffs for their services.
According to 62% of respondents, the financial impact of Namaf’s decision not to increase the standard tariffs for 2024 was significant.
The NPPF noted that it is therefore essential to study the effects of the downward pressure on practitioners, as the key question is: “For how long can the private healthcare industry absorb the cost-saving strategies of the funds before the industry becomes unsustainable?"
The forum also warned: "Namibia is home to a world-class private healthcare industry. It has taken decades of investment, development and capacity building to reach this point. The moment it is destroyed, it will take decades to bring private healthcare back to its current level."
The majority of respondents (77%) also agreed that Namfisa's lack of action has had an "extremely negative impact on the effective regulation of medical funds, leaving members and service providers without any recourse against the actions of the funds."
Legal action considered
Referring to the ICD-10 coding system that private practitioners are now forced to use or risk having their claims not processed, the majority agreed that the system will not effectively tackle fraud and abuse.
The Health Professions Council of Namibia (HPCNA) recently also announced an increase in its fees, including annual registration fees.
According to the new fees, service providers who are not Namibian citizens must pay significantly more than Namibian citizens, even in cases where practitioners have been practicing in the country for years. According to the NPPF survey, nearly 60% of respondents are willing to financially contribute to a legal action challenging the inequality in the fees.
– [email protected]
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