N$120 000 Medical Costs In 24 Hours
I WRITE this open letter to the Minister of Health and Social Services, Richard Kamwi, to share my most pressing concerns regarding medical care in Namibia and to, hopefully, stimulate some debate and subsequent action on this matter.
I was convinced to take this step due to an accident that took place at my farm near Grootfontein where one of my workers was severely injured when a maize planter ran over him.
Due to previous horrific experiences at the state hospitals at Tsumeb and Grootfontein, I could not with a clean conscience consider taking my worker to either of these facilities for urgent care. I, therefore, arranged for him to be seen by a private general practitioner (GP) and to be admitted to a local private hospital. He received excellent care but a sonar examination indicated abdominal bleeding and the GP decided to refer him to Windhoek for surgery. This was early in the evening.
I arranged with a private ambulance service – the only local option available – to transport the patient to Windhoek as soon as possible. This was done – but not until I had submitted proof of payment to the amount of N$30 730. My GP arranged for admission of the patient at a private hospital in Windhoek and I had to send proof of payment of a deposit prior to submission – another N$60 000.
On arrival, a Windhoek surgeon saw the patient and, after blood tests and a scan were performed, diagnosed a liver laceration. The patient was scheduled for surgery some 13 hours later but passed away shortly before being taken to theatre. Further costs? N$10 000 for the scan, almost N$4,000 for the blood tests and almost N$9 000 for the surgeon (without the patient having been operated on) and most importantly, the loss of a life. Monetary costs of almost N$120 000 were incurred within 24 hours.
Can this be considered acceptable, fair and justifiable?
This is totally unaffordable for the vast majority of Namibians and leave them with only two options: either make use of state medical facilities (which at present is simply no option due to the most shocking level of care at these facilities) or join a medical aid to get access to private medical care.
Which brings me to the root of the problem: the very existence of private medical aid organisations and the role they play in Healthcare in Namibia.
Examples such as the incident described above have convinced most middle-to-high income citizens (those not employed by GRN) that they cannot survive without membership of a private medical aid due to the astronomic costs of medical care. They join medical aids since your state medical facilities do not offer an acceptable alternative. They pay huge amounts of money to belong to these medical aids in order to enjoy peace of mind that medical costs would be taken care of when required.
Medical aids are funds that do not generate profit. They are however administered by companies which, from an administrative fee, generate enormous revenues.
The administrators generate more income if they increase membership premium fees for their funds and by attracting more members.
The result of the involvement of medical aids in the supply chain of medical services (in the absence of sound and reliable state medical care) is that both the service provider as well as the recipient of such a service loose all incentive to curtail costs.
The medical aid member wants to get value for his money and accepts whatever costs the service providers charge. The service providers can charge ridiculous amounts of money since a third party foots the bill and the medical aids will simply increase their premiums for the next year to cover the spiralling costs. Not because the real cost of medical care is spiralling out of control: to the contrary, the first line of medical care is very affordable: medication is more affordable and accessible than ever before and general practitioners are charging peanuts for their services. The problem arises at the level where state services should have been up to scratch: hospitalisation, specialist care, pathology, radiology and ambulance services.
Any analysis of Namibia’s medical expenditure will show you that these services (required far less frequently than GP consultations and prescription medicines) are responsible for the largest portion of the total costs. Exactly here the costs are unjustifiably high which currently necessitates Namibians to join private medical aids.
I have no issue with any person or business providing private medical care of whatever type in our country (and making money by doing so) as long as there is an acceptable alternative available in the form of state medical care.
Patients should however not be held at ransom by the present private medical industry as is the case currently in the effective absence of state medical care. Access to good medical care is a fundamental right that every Namibia should be able to enjoy.
Minister Kamwi, you and the Government of the Republic of Namibia can put an end to the exploitation of your citizens by restoring state medical care to the levels experienced prior to independence. Every citizen should be able to receive the required medical care through your hospitals at an affordable price- I’m not advocating free medical care for any but for the most needy.
By providing sound hospitals and by employing motivated and qualified staff, you will experience a return to your facilities by private patients and a subsequent inflow of revenue. Most importantly, every Namibian would have access to good medical care.
The above would diminish the role medical aids play in the provision of health care in Namibia. It would make healthcare providers more conscious of costs and will lead to patients avoiding service providers who charge exorbitantly for their services. It will lead to those service providers who currently get away with charging immorally high charges to change to acceptable levels or to be left out in the cold. It will allow general practitioners to play a more significant role in the provision of medical care and to earn income commensurate with the role they play.
Whilst Namibia undeniably has some of the best private medical services available in Africa, most of its citizens cannot access these services due to the high cost thereof. The services offered at state facilities are unfortunately simply non-existent and I can substantiate this statement from personal experiences with my personnel at such facilities in the past. That leaves the majority of our people without access to good medical care.
You can change that by simply restoring what previously did exist: an effective and proud state hospital service.
Andre Compion
Ghaub, Grootfontein