Doctors 'forced' to demand co-payment

Doctors are currently ‘forced’ to either no longer perform any hospital procedures, or demand significant co-payments from patients."We are at the point of insolvency given the latest decision by [medical aid fund] administrators to again not give us an annual increase. Since 2021, there has also been a significant and systematic decrease of procedures being performed in hospital," Dr David Weber, chairperson of the Medical Association of Namibia (MAN), said.The Namibian Association of Medical Aid Funds (Namaf) announced late last year that its standard rates would not be increased.According to Weber, the gap between fair compensation for a doctor&#039;s services and what Namaf [and by implication the administrators of medical funds] considers to be fair has widened so much that it can be considered “unethical”. He further made reference to operating costs for healthcare practitioners, which skyrocketed in the past few years and were mostly absorbed by practitioners.According to MAN, annual payments to hospitals - around 34% of medical aid funds’ expenses since 2018 - are negotiated, while compensation for the cost of medication (on average 17% of the annual expenditure) is simply increased, as per the Namibia Financial Institutions Supervisory Authority (Namfisa) annual report.Weber claimed that like many other associations, MAN was not consulted about the proposed adjustments in standard rates which were accepted by administrators, adding that they were, instead, “unceremoniously informed during the festive season via email".Strictly regulatedDoctors, dentists and other allied health practitioners are strictly regulated by various statutory bodies, Weber said, such as the Health Professions Councils of Namibia, the finance ministry and the Namibia Medicines Regulatory Council. Claims are also heavily policed for fraud, abuse and waste, he added. Claims for general practitioners were just 9% and specialists just 11% of total medical aid expenditure, while non-related health expenditure - incurred in the quarter ending 30 June 2023 - was N$135.7 million. The latter is, according to Namfisa&#039;s statistical and quarterly report for 2023, an increase of 3.2% on an annual basis and mostly goes to administrators.According to Weber, it appears that the milieu of fund administration is focused “exclusively on healthcare fraud", which is present in all spheres of the fiscal society, but is largely overshadowed by the "suspected yet unsubstantiated waste and/or rising costs linked to facilities that have theatre lists, do procedures or admit patients”. However, this is not actively spotlighted and hunted down by administrators with the same zeal, MAN said.Weber stressed the association&#039;s support for healthcare practitioners’ right to demand legitimate and fair compensation from patients, regardless of Namaf&#039;s standard rate - which is "neither fair nor actuarially accurate".He described doctors as forming the base of the healthcare pyramid, which is now being toppled due to misinformation. He added that they believe that medical aid funds are to blame for the current sustainability crisis.

Doctors 'forced' to demand co-payment

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Namibian Sun 2025-04-04

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Doctors 'forced' to demand co-payment

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Namibian Sun 2025-04-04

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