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Thursday 17 January 2019
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GPs vs PSEMAS

 

…On mandatory consultation fees

Several general practicioners have in recent years taken a stand to stop treating state medical aid holders unless a consultation fee is paid up front, with doctors claiming the situation was prompted by the Public Service Employee Medical Aid Scheme’s alleged slow payment system.
“The issue of many doctors not accepting PSEMAS is not something new in private practice, many well-established doctors, especially specialists have been doing it for years. This is due to the fact that PSEMAS medical claims are not paid on time. For instance, you see a patient today but most likely you will get that money paid in three to four months’ time,” said associate doctor at West Care Medical Centre in Windhoek, Dr David Emvula.
He added: “Running a practice is a business like any other business and doctors too have bills to pay. It is more a business decision by some doctors. So to keep the business cash flow many doctors require PSEMAS patients to pay cash for their consultations, which they can claim from PSEMAS.”
Another doctor, who spoke on condition of anonymity, also shared Emvula’s sentiments.
“It [requesting consultation fees] is not something new, the situation has become so bad doctors cannot take it anymore – payments being delayed even for 4 months. In the end, a medical practice is a business as well and one can’t run it without capital,” said the general practitioner.
“Why do you think private hospitals do not accept PSEMAS patients without a top up? It’s simply because of the same reason, which is the delay when it comes to claim payments.
“If other medical aid can pay on time why can’t PSEMAS do the same?  It is really not fair to the patients but it must be understood that doctors are not doing this to punish the patients, we must also have an income to run the practice and the patients,” the doctor said.
MetHealth Fund manager, Jo-anne Pote, when contacted yesterday, said she was not mandated to speak to the Press about PSEMAS, but she briefly indicated that the fund has not received any complaints of doctors being paid late. MetHealth is the authorised PSEMAS administrator.
Efforts to get hold of Ettienne Coetzee, the Chief Accountant at Ministry of Finance who heads the medical aid section, proved futile.

Cost of private healthcare
With many Namibians opting for private rather than public healthcare, the cost that comes with it means only those covered by medical aid schemes can access it.
The Namibian Association of Medical Funds (NAMAF) tariffs continue to raise eyebrows, and private healthcare is seen as moving out of reach of many Namibians.
Giving birth has become a costly exercise of late, especially when done at private hospitals, as expectant mothers due for caesarean section are subjected to pay a minimum fee of N$16 376 on the first day of admission followed by a daily fee of N$3 503 until they are discharged, as per NAMAF’s benchmark tariffs.
For natural birth, N$10 428.80 is required on the first day of admission followed by a daily fee of N$3533.50.
This is according to the 2016 benchmark tariffs applicable to private hospitals.
Private ward admission costs patients just over N$3 700 daily, and hospitals are expected to obtain a certificate motivating the necessity of the accommodation in a private ward.
The Intensive Care Unit has become a lucrative business for hospitals in the country, with the benchmark tariffs set at N$14 694.60 for specialised ICU admission.
The Neonatal ICU tariffs stand at N$13 094.60 per day.
The private healthcare system boasts world-class hospitals, modern equipment and the best doctors. This is in stark contrast with the public healthcare system, which in most cases is ranked second-class because doctors often prefer to move to the into the lucrative private sector.
The cost of private healthcare has prompted authorities to battle it out in court after the Namibian Competition Commission first challenged the use of benchmark tariffs in 2010.




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