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Sunday 21 April 2019
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Clinicians Scapegoats for PSEMAS Mismanagement

The Ministry of Finance this week hosted the medical industry stakeholders to discuss PSEMAS financial health, clinician contracts and proposed PSEMAS reforms.
Minister of Finance, Calle Schlettwein appealed to the healthcare industries for collaborations in order to save the scheme, emphasising that the clinician contracts signed with clinicians is central to this salvage effort.
Over 1000 clinicians have signed annual contracts to service PSEMAS members. The doctors present at the meeting lamented the coercive and prejudiced nature of the contracts in that they require doctors to service patients for rates five years behind the private medical aid rates.
Private medical aid rates are computed scientifically and consider the costs doctors incur when servicing patients.
Clinicians have to wait in excess of 60 days to get paid. On at least one occasion the amount paid to a doctor was less than N$2.
The rooting out of fraudulent stakeholders and fraudulent clinicians in particular, was repeatedly emphasised.  Some clinicians voiced their discontent that the entire industry is being victimised for the transgressions of a few.
Elizabeth Kharuxas, Deputy Director in the Ministry of Finance responsible for PSEMAS operations relayed that the pharmaceutical and hospital costs are the main services being bought by PSEMAS.
The Patriot learned that just about all private medical aids make use of third party providers to provide pharmaceutical and hospital benefit management services to prevent over utilisation of these services.
Even though PSEMAS has been administered by Methealth for the last decade, these pharmaceutical and hospital benefit management services have not been part in parcel of their service offering. Kharuxas mentioned that, part of the envisioned reforms to PSEMAS include much needed IT System enhancements.
She made mention of the fact that the current administration systems lack internal controls and safeguards.
She went on to say that the government employees’ payroll system, Methealth administrator system and the Office of the Prime Minister HRM system currently don’t speak to one another.
There is a reported 8700 ghost members on PSEMAS which the current HRM system cannot identify, necessitating the need for a desktop member audit.
Furthermore, The Patriot has reliably learned that Methealth are planning a new administration system implementation in the next 18 months.
The Patriot also understands that PSEMAS membership has grown by 50% over the last five years subsequent to the bulging public service employee corps while 50% of PSEMAS members have migrated from the standard to the high option.
The average monthly per member expenditure to the scheme on the standard option is N$900 and N$3000 for the high option while the cost difference of these two products to the member is negligible.
The PSEMAS standard option provides almost no incentive for members to stay on it owing to poor benefits of the standard option relative to that of the high option.
Schlettwein reassured the industry that Methealth’s contract has been extended for another 12 months ending 31 March 2020.
Executive directors at the meeting could not shed much light on whether a service level agreement between PSEMAS and Methealth existed and what it entailed.
There are many who believe that PSEMAS would be better off as an independent entity with its own board, management, systems and wallet.
The annual PSEMAS budget is approaching the N$3 billion mark. This amount is more than most state owned enterprise budgets.
In the past the ministry of finance has allowed the MVA fund and more recently NAMRA to become independent entities.




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