….Only 490 229 covered by medical aid funds
By Staff Reporter
About two million Namibians are not covered by a medical aid or basic healthcare provider.
A collation of data between beneficiaries of the nine private medical aid funds and those from the public medical fund, PSEMAS, indicates that only 490 229 of the 2.48 million Namibians have health care cover.
The latest statistics from the Namibian Association of Medical Aid Fund’s (NAMAF) 2017 Annual Report shows that only 196 276 Namibians have access to private medical care.
The public medical aid, PSEMAS, caters for the healthcare needs of at least 293 953 beneficiaries. The rest of the citizenry who cannot afford private healthcare are solely dependent on government health facilities. In total, more than 2 million Namibians do not have any form of health cover.
Private quality healthcare roughly refers to easy access to general practitioners, dentists and medication. Having access to adequate medical cover can drastically improve the quality of life and life expectancy of a person.
Namibia is regarded as an outlier in healthcare spend because it invests “huge amounts of money on few people.
The report highlights that the private sector only provides care to 8% of the population”, with the country’s overburdened public health sector forced to take care of the rest.
But the number of people with medical aid does not equal the number of people using the private healthcare sector.
While it is true that the majority of Namibians do not benefit from private healthcare, it is misleading to equate medical scheme coverage – or the lack thereof – with the exclusive use of a particular healthcare sector.
The leading barrier to private healthcare in Namibia continues to be the price which subsequently forces the overwhelming majority of Namibians living without medical cover put increasing pressure on the public health system.
According to the report, the total value of claims received increased from N$2.69 billion in 2014 to N$3.64 billion in 2017. The total value of the claims paid by medical aid funds increased from N$2.33 billion in 2014 to N$3.14 billion last year.
Of the benefits paid in 2017, hospitals account for 34%, medicines (17%), medical specialists (12%) and general practitioners (10%).
NAMAF has cautioned that high annual increase in contributions has the potential to result in unaffordable healthcare.
“The impact of the high annual increases in contributions coupled with the high increases in out-of-pocket expenditure will have a negative impact on the access to and the affordability of healthcare going forward,” warned NAMAF.
The World Health Organization’s (WHO) guidelines indicate that public health facilities should not exceed 10 000 people per clinic.
Despite the slow increase of people with access to private healthcare, the fund’s chairperson Benny Amuenje noted that the change of NAMAF’s reporting line from the Health ministry to the Ministry of Finance remains a challenge. “This was problematic, since NAMAF regulates the conduct of medical aid funds, which relates to health and not finance, and it created role confusion between Namfisa as Registrar and financial regulator and NAMAF as market conduct regulator,” lamented Amuenje.