Private doctors have expressed concern over the manner in which the public medical aid scheme is being managed and also lamented the tedious process doctors are subjected to before they are given clearance to start practising.
Eben De Klerk, who represents the Namibia Private Practitioners Forum, says managing the Public Service Employee Medical Aid Scheme (PSEMAS) prudently is paramount because most private doctors might close down in the absence of PSEMAS.
The situation is so dire as PSEMAS has been defaulting on payments to pharmacies since the first week of December 2016. The situation is said to have placed a lot of strain on pharmacy owners, a situation which subsequently extended to wholesalers such as Nampharm and Geka.
The debate whether to increase members’ monthly contributions has been discussed widely in recent years, but De Klerk is of the view that changing the amount paid by PSEMAS members could have legal implications.
“The problem is that you sit with vested rights. So, legally it is going to force members to pay more, because they are going to have to take it from their basic salary, or increase their cost to company package to increase the amount,” he said in a recent interview.
“The whole PSEMAS model was not designed as a sustainable fund with capacity to stand alone. It is only a vote on the government’s expense. People need to understand that PSEMAS is not a fund, it is just a vote because the contributions made by members cannot even pay for PSEMAS’ administration needs,” he said.
De Klerk reiterated that the doctors are concerned that if PSEMAS fails to provide insurance to its members, the medical practices will suffer and most of them will close down if it [PSEMAS] runs out of cash. I guess some [doctors] will leave the country and some will look for alternatives and even contemplate working for the state. “That is why we should not wait to get to a point where PSEMAS says it cannot afford to pay doctors. We must proactively start designing a model that is positive and attractive so that medical practitioners can form partnerships with government. I am sure such a model does exist,” said an optimistic De Klerk.
He said despite the lack of health professionals in the country, there are a lot of medical practitioners who are willing to work with the State who have the health of people at heart.
“Yes, there are those who want to make money, but disillusioned and quickly change to specialists. The medical aid funds don’t want doctors to refer patients to specialists because the moment that happens, the expenses double because specialists charge substantial fees,” said De Klerk.
De Klerk also refuted claims that doctors have been milking the State purse with exorbitant claims in recent years.
There are 293 953 beneficiaries benefiting from the PSEMAS.
Official figures indicate 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 percent from N$129 million in 2012 to N$363 million in 2016.
De Klerk mentioned that doctors have to fork out about N$750 000 to set up a basic practice, this includes you personnel and administration fees and so forth.
“Our healthcare is perceived to be expensive but what one has to understand that in other countries healthcare is not cheap, it only looks cheap because their governments subsidise or pay for it. Healthcare has a certain price and if government does not provide enough incentives for people to go and study there will be no doctors. So there has to be some minimum payment for it,” he said.
When you consider other professions such as accounting where people study for less years than it takes to become a doctor, doctors receive peanuts.
“But people do not see that because accountants do not deal with the lives of people on a daily basis. Accountants are not even forced to work on weekends and they work in clean working environments without having to worry about people losing their lives in front of them. I know of audit firms that will easily charge you about N$3 000 per hour but nobody is concerned about that. But because the man on the streets does not use those services it is hardly spoken of.”
De Klerk said doctors are among the least paid professions.
“The problem with doctors is that they want to look like professionals, they want to buy big houses and as a result most doctors in this country are heavily indebted. The flashy life creates a misperception that doctors are making a lot of money but in real terms the bulk of them are really struggling to make their ends meet,” he said.
De Klerk also bemoaned the “bureaucratic process” that upcoming doctors have to face when applying for practice licences with Namibia Medical Aid Fund (NAMAF).
We have a long way to go when it comes to tackling unlawful tariff settings, he said.
“Then also the bureaucracy in operating a practice and now. There is a directive issued that doctors must have tax certificates by all government offices before making any systems. Such directives are issued despite government knowing the receiver’s office is not capacitated.
“It is unlawful because the Ministry of Health and Social Services has its requirements for doctors to receive a practising licence, but now the Ministry of Finance bulldozes its directives by adding directives that are not even recognised by law,” he lamented.
He warned that the tax directive could force doctors to close their practices or to operate illegally.
“The other thing is the Namibia Medicine Regulatory Council, which again is an example of the bureaucratic processes and they are completely ignoring a Supreme Court judgment, which prevents them from using the proximity of a pharmacy as a criteria when setting up a practice.
“We are talking about doctors who have been dispensing medicine for over 30 years and suddenly they are told there is a pharmacy next door hence you are not allowed to dispense any further. These doctors have many patients coming to them for treatment but now they have to go in the row of the pharmacy,” he said.
De Klerk said the decision to limit the proximity between medical practices and pharmacies “is a self-serving thing”.
“The Medicine Regulatory Council is managed by pharmacists but in terms of the Act they are only allowed to assess the qualification. You must consider the fact that the training of doctors is far better than that of pharmacists, so one wonders how you have pharmacists prescribing what doctors should and should not do,” he said.
He added: “As I said earlier, there is a self-serving thing and even Minister Haufiku (minister of health) has a problem with it and wants to change the legislation but it takes time unfortunately.”