In fact, years of negligence have taught Government a lesson on how to spend money meant to cover for the medical needs of civil servants, a situation which has led to a full-blown investigation by the finance and health ministries into the entire public medical aid system to close loopholes in order to minimize and eventually prevent any leakage or wastage.
Finance minister Calle Schlettwein yesterday admitted that PSEMAS is full of loopholes, but was quick to point out that remedial actions have been undertaken.
There are 293 953 beneficiaries benefiting from the PSEMAS.
General practitioners raked in almost half of the N$3.3 billion paid by PSEMAS between 2012 and 2016.
During that period PSEMAS paid out N$1.5 billion to general practitioners, hospitals (N$1.3 billion) while N$495 million went to specialists.
The total increase in benefits paid to general practitioners increased from N$282 million in 2012 to N$319 million in 2016 while that of hospitals increased by over 60% from N$129 million in 2012 to N$363 million in 2016.
As for specialists, benefits paid to them ballooned from N$58 million in 2012 to N$138 million in 2016.
Most of the money paid to specialists catered for family medicine which is mostly dispatched over the counter in pharmacies, followed by ophthalmologists, surgeons and paediatricians.
Statistics from the Health Professions Councils of Namibia indicate that there are 1618 medical practitioners and specialists on the national register. This includes Namibians and foreign nationals.
However not all of these registrants are practicing in Namibia. The numbers do not include dentists who are also referred to as “doctors” and registered under the same the Medical and Dental Council.
“We are trying to improve the recording mechanisms in order to improve the cards and the biometrics in order to make sure that it is not misused,” added Schlettwein.
“This (PSEMAS) is a very vulnerable spot that we have, we need to review and tighten it which is what we are busy doing,” said Schlettwein.
“In fact we have involved the Anti-Corruption Commission (ACC) in one of the cases that is not completed but the first phase has been concluded,” added Schlettwein.
Further, Schlettwein said PSEMAS management in conjunction with the Ministry of Health and Social Services have started investigations to identify the underlying problems and the risks within the PSEMAS system in order to secure and protect the system from any untoward transactions.
The rate at which the scheme is disbursing funds is worrying to the authorities, with many fearing that the scheme could run dry if changes are not instituted.
It will be an embarrassment for the State because the premium paid by civil servants is way below the average market rates charged by private medical aid schemes.
Despite the high cost of private healthcare and unaffordability of medical aid membership, healthcare providers and schemes continue to increase rates beyond the reach of many Namibians.
The finance minister confirmed that an investigation to identify any fraudulent activities is underway.
Schlettwein also revealed that the Anti-Corruption Commission(ACC) is currently investigating a case in which a foreign medical practitioner allegedly defrauded the State.
This investigation adds weight to the case of local doctors who last year called on Government to adopt strict monitoring and control measures over foreign doctors.
The Patriot recently reported that the healthcare space is emerging as a source of friction between local and foreign doctors, with expats standing accused of cashing in on public healthcare funding at the expense of delivering quality healthcare.
Areas of concern listed by some private doctors include private health service funding; regulation and private health services licensing; health service market industry protection for locals vs foreigners; protection of patients against poor treatment, over – servicing and unregulated tariffs; itinerant practice and working outside the scope of practice and registration of foreign nationals to practice health professions in Namibia.
A team of local doctors joined forces last year and wrote a letter – signed by NAMPath Laboratories managing director Esegiel !Gaeb – to the health minister in which the frustrations over the mushrooming of health facilities owned by foreigners were revealed.
He alleged that practices owned by foreign doctors are solely focused on “cashing in on our health funding while also being aware of Namibia’s apparent lack of resolve to prosecute unethical and illegal practices.”
In the correspondence, !Gaeb warned Government of the imminent collapse of the private healthcare funding system if it is not sufficiently protected.
At present, the biggest chunk of funding private health facilities is through the Public Servants Medical Aid Scheme.
“We propose that a new mechanism to administer PSEMAS to control its use be put in place. We appreciate the establishment of the coordinating committee to oversee the work of the contracted administrator.
“However claims for specific procedures and laboratory tests are very technical for each field and can only be verified by another professional with the same training as well as looking at international trends,” he said.
He also called for investigations into any irregular claims by health professionals, claiming:
“We have names of foreign practitioners that are known to abuse the claims system.”
Health minister Dr. Bernard Haufiku this week indicated that that the days of foreign doctors setting up private practices in the country are numbered, adding that qualified doctors, whether Namibians who studied abroad or foreign nationals who want to set up private practices, will be required to do public service for at least five years.
This condition will be effected once the-Health Professions Council of Namibia Bill that is due for tabling next month is passed by Parliament.
The local view
Local doctors who spoke to this publication in the past were in support of stricter regulations for foreign doctors.
“As a foreigner, you are not allowed to work in any other country just like that, but here everything is handed to you whether you are a Namibian or not. Why should foreigners be doing internships here and get paid same amount as Namibians?” questioned the health professional at the time.
One of the doctors claimed that at times foreign health professionals end up doing internship for more than three years which is the minimum number of internship years offered by the health council.
“This partly shows that some of them lack medical skills, yet they are allowed to treat patients.”
“In the regions, foreigners are making money by over-charging patients even for a simple appendix removal or C-section. They treat patients in private and deplete their medical aids and in the end dump them in state facilities. Without coming across as xenophobic, some of these foreigners are making a fortune from our people despite healthcare being considered as a basic need,” said another doctor.
Another local doctor bluntly said: “Have you ever thought why only those who are well paid or those with medical aids seek medical treatment at private facilities, the rest of the nation must go to state facilities. This shows that the people who run the system do not trust it.”