WINDHOEK: Minister of Finance and Public Enterprises , Iipumbu Shiimi has attributed government expenditure of about N . dollars 3 . 2 billion per year on the Public Service Medical Aid Scheme ( PSEMAS ) to the scheme using outdated 2014 benchmark tariffs . This financial strain has prevented the adjustment of tariffs to more current levels , leading to reduced healthcare for civil servants as some healthcare providers opt out of PSEMAS contractual agreements . Shiimi in a recent interview with Nampa acknowledged receiving complaints from healthcare professionals regarding the use of the 2014 tariffs of the Namibia Association of Medical Aid Funds ( NAMAF ). Although NAMAF has availed the standard benchmark tariffs for 2023 , the government medical aid scheme continues to use older rates due to budget constraints . According to Shiimi , the government did not adjust the tariffs to the current rates as it already spends about N . dollars 3 . 2 billion per year on PSEMAS . ‘ It is a balancing act . If we are go
ing to increase the tariffs , it means government is going to pay even more , we will end up paying N . dollars 4 billion for PSEMAS ,’ he said . The minister said there is a lot of abuse within the system , generally between the doctor and patient , with doctors claiming without treating the person . Currently , civil servants have two options . For the high option , main members pay N . dollars 240 per month and N . dollars 120 for each dependent , while the standard option costs N . dollars 120 for the main member and N . dollars 60 for dependents . Meanwhile , Namaf ‘ s Stakeholder Relations and Communications Manager Uatavi Mbai , said as per the Namaf Act , PSEMAS does not fall under the private health funding industry , but it has aligned its tariffs to Namaf ‘ s structure of coding and pricing . In terms of the 2016 amendment to the Medical Aid Funds Act , the Minister of Finance oversees Namaf . She explained that PSEMAS ‘ s reliance on the outdated 2014 tariff schedule , with a 20 per cent markup ,
was intended to control costs , but there was a failure to understand that ulitisation is a driver of frequency of service or the volume of that service . ‘ The fact that people are seeking services more is driving up costs ,’ she said . The reimbursement model that is currently being used is another challenge as it lacks transparency in costs for tools used by healthcare providers . ‘ You as the member would not know what that service what that cost is , what that intervention is , whether gloves or syringes were really used . So those are the volumes in terms of how the reimbursement model works that is causing the cost of healthcare to also be inflated ,’ she said . Mbai further noted that Namaf introduced the International Classification of Diseases ( ICD ) in 2021 . The ICD indicates why a member was seeking treatment and the diagnostic code links to the procedure code , noting that currently in some instances healthcare professionals are using dummy codes . Namaf is also in the process of introducing a
coding structure for medicine and consumables in Namibia , which is expected to be launched in January 2025 . ‘ The current model is based on single exit in South Africa but once the medicine lands in Namibia , we don ‘ t have the cost of that product . This coding structure is going to provide clarity in terms of what medical aid funds are actually reimbursing for , which PSEMAS will also be piggy – backing on ,’ she said . She echoed Shiimi ‘ s sentiments that while PSEMAS members contribute relatively low amounts , the high usage of services continues to strain the scheme .
Source: The Namibia Press Agency