NAMAF’s tariff decision 'unlawful'
The announcement by the Namibian Association of Medical Aid Funds (NAMAF) that the 2023 standard tariffs will remain unchanged until at least the end of the first quarter of 2024, and possibly longer, effectively constitutes a reduction in members' benefits because funds will not compensate members for medical inflation.
Medical inflation is largely driven by external factors. Some medical funds have already indicated that members' contributions will increase by almost 11%, subject to approval by the the Namibia Financial Institutions Supervisory Authority (Namfisa).
The Namibia Private Practitioners' Forum (NPPF) is now in consultation with the broader private healthcare industry to request the Registrar of Medical Funds – Namfisa – not to allow NAMAF and medical aid funds to continue with their "unlawful actions" and to covertly reduce members' benefits.
The NPPF responded to a letter to healthcare providers stating that increasing rates would be irresponsible without considering various interventions or strategies due to cost trends and the resulting impact on the financial sustainability of funds.
Without consultation
NAMAF says in a letter by its CEO Steve Tjiuoro that these strategies are complex to develop and implement, and a gradual approach is needed. Referring especially to management strategies for consumption where providers will be invited to help manage health inflation, Tjiuoro says the goal is to develop programmes where providers and practitioners who commit to active contributions will receive incentives.
Therefore, this year's rates remain as they are until the intended management strategies are implemented to ensure the sustainability of an industry that includes service provision and financing.
However, the NPPF says the decision was made without any consultation with medical fund members or service providers. It also refers to the implementation of two options, which, according to this model, involve medical funds paying higher benefits to members whose service providers decide to be part of it and then paying fewer benefits to members whose providers choose the opposite.
"Providers who choose to participate (opt in) are severely restricted in the rates they may charge and are subjected, among other things, to a NAMAF disciplinary process," says NPPF in a statement.
Violation
It also accuses NAMAF of attempting to acquire powers it does not have through its empowering legislation. This specifically includes powers over service providers and at the expense of members of medical funds.
"NAMAF is an administrative body, and its unilateral decisions and actions without involving members or their service providers are unconstitutional and a violation of the right to just administrative action as set out in Section 18 of the Constitution."
The NPPF rejects NAMAF's powers to set standard tariffs as well as the decision to reduce members' benefits by allowing funds not to increase them for 2024, "knowing that healthcare inflation will rise" and providers have little control over it.
Medical inflation is largely driven by external factors. Some medical funds have already indicated that members' contributions will increase by almost 11%, subject to approval by the the Namibia Financial Institutions Supervisory Authority (Namfisa).
The Namibia Private Practitioners' Forum (NPPF) is now in consultation with the broader private healthcare industry to request the Registrar of Medical Funds – Namfisa – not to allow NAMAF and medical aid funds to continue with their "unlawful actions" and to covertly reduce members' benefits.
The NPPF responded to a letter to healthcare providers stating that increasing rates would be irresponsible without considering various interventions or strategies due to cost trends and the resulting impact on the financial sustainability of funds.
Without consultation
NAMAF says in a letter by its CEO Steve Tjiuoro that these strategies are complex to develop and implement, and a gradual approach is needed. Referring especially to management strategies for consumption where providers will be invited to help manage health inflation, Tjiuoro says the goal is to develop programmes where providers and practitioners who commit to active contributions will receive incentives.
Therefore, this year's rates remain as they are until the intended management strategies are implemented to ensure the sustainability of an industry that includes service provision and financing.
However, the NPPF says the decision was made without any consultation with medical fund members or service providers. It also refers to the implementation of two options, which, according to this model, involve medical funds paying higher benefits to members whose service providers decide to be part of it and then paying fewer benefits to members whose providers choose the opposite.
"Providers who choose to participate (opt in) are severely restricted in the rates they may charge and are subjected, among other things, to a NAMAF disciplinary process," says NPPF in a statement.
Violation
It also accuses NAMAF of attempting to acquire powers it does not have through its empowering legislation. This specifically includes powers over service providers and at the expense of members of medical funds.
"NAMAF is an administrative body, and its unilateral decisions and actions without involving members or their service providers are unconstitutional and a violation of the right to just administrative action as set out in Section 18 of the Constitution."
The NPPF rejects NAMAF's powers to set standard tariffs as well as the decision to reduce members' benefits by allowing funds not to increase them for 2024, "knowing that healthcare inflation will rise" and providers have little control over it.
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