Doctors want transparency in healthcare funding

THE newly formed Namibia Private Practitioners’ Forum (NPPF) claims that the four medical aid funds, as well as the regulator, the Namibia Financial Institutions Supervisory Authority (Namfisa), refuse access to basic information such as the financial statements of medical aid funds.

After an inquiry into the healthcare funding industry, the forum said last week that a lack of transparency on the part of the medical aid funds is possible because there is no legislation in Namibia that guarantees consumers access to information. The NPPF, which has a membership of more than 200 healthcare professionals, said several instances of people with conflicted interests serving in senior positions were found. It further stated that the Namibian Association of Medical Aid Funds (Namaf), a statutory body that determines medical aid tariffs and controls the computer system with which healthcare professionals claim payment from medical aid funds, impedes free-market competition which could make medical aid fund contributions more affordable. After the NPPF lodged a complaint with the Namibian Competition Commission, Namaf and the medical aid funds argued that laws promoting competition do not apply to them. The competition commission is still to pronounce itself on this matter. But the NPPF said if the commission accepts the argument of Namaf and the medical aid funds, there will be no free-market competition among open medical aid funds.Also, the NPPF said, although Namaf is supposed to protect members of medical aid funds, the Namaf management consists of senior managers of those very same funds. It thus questions Namaf’s mandate and on whose behalf it exercises its powers. The NPPF said if the proposed Financial Institutions and Market Bill is adopted in its current form, Namaf will continue to exist unchanged. Namaf is funded by members’ contributions, which run into the millions a year, the NPPF said, while Namfisa, which is the actual regulator of the sector, receives only a fraction of this money. It said administration fees in open medical aid funds are as much as four times higher than the ceilings prescribed by a Namfisa circular in 2002, and twice as high even if Namfisa’s ceilings are amended for inflation. From 2008 to 2010, it said, medical aid fund administration costs, including managed care, increased by 100 per cent more than healthcare claims. Operational costs – excluding administrative fees and managed care – increased 400 per cent more than healthcare claims. Furthermore, the forum said, regulations prescribing how medical aid funds invest their funds are interpreted by medical aid funds as allowing them to invest up to 65 per cent of fund assets in any asset class of their choice, including unlisted investments that can be exposed to high risk. The NPPF has registered its concerns with the Ministry of Health and Social Services and the Ministry of Finance. It also made submissions to Namfisa on July 11. ‘The NPPF will continue to fight for a more ethical and transparent healthcare funding industry and if that becomes impossible, it will explore other avenues, not excluding the possibility of a new system of funding on which healthcare professionals can keep a watchful eye,’ the forum vowed.