Medical funds cross swords with Medi-Clinic

THE Namibian Association of Medical Aid Funds (Namaf) yesterday vowed to stand its ground, insisting that “it cannot allow any single hospital or group to control and manipulate pricing of healthcare in Namibia”.

Hence, with effect from September 12, the guarantee payment system with the Medi-Clinic Group will be cancelled. “The effect of the cancellation will mean that medical aid funds will no longer deal directly with Medi-Clinic Group,” said André September.Speaking at a press briefing, September said the healthcare industry was a critical sector that could not be left open to manipulation.In the event that members of private medical aid funds prefer utilising the facilities of Medi-Clinic, Namaf said, they should be prepared to pay the deposit as determined by Medi-Clinic.”In addition, the funds will reimburse the member upon producing an invoice in accordance with the benchmark tariffs and the fund rules.The members, in turn, will have to settle their accounts with Medi-Clinic.”However, Namaf said it would not reimburse the deposit, which falls outside the tariff regime.Members of the public were advised to utilise other private hospitals aligned with Namaf tariff structures, namely Rhino Park, the Roman Catholic Hospital, Welwitschia and the Tsumeb Private Hospital.The Namaf boss said the decision to cancel the guarantee payment system was meant to be in the interest of medical scheme members.September said the country could not rely on monopolies in an industry as important as healthcare.The Namaf decision followed Medi-Clinic’s insistence that medical aid fund members pay an 18,5 per cent deposit upfront before hospitalisation.For instance, a pregnant woman has to pay a deposit of N$2 600 for a Caesarean and about N$1 550 for a normal delivery.September explained that the dispute with Medi-Clinic arose from the 2005 tariff structure that Peter Sanders, then chairman of the Namibian Association of Private Hospitals (NAPH), proposed to Namaf last year.”In light of the prevailing insecurities at the time regarding the cost of medicine, the private hospitals agreed to remove all margins from ethicals and surgicals and provide medicine at the South African single-exit price.After deliberations on the tariff structure, Namaf agreed to the pricing system with room for adjustments.Namaf however alleged that after a recent assessment, hospitals as an industry were benefiting from higher tariffs on one hand while on the other they were not able to provide medicine at a cost that could balance the impact of the increases.The result was a skewed and unfair impact in favour of hospitals.”In line with our agreement and in order to create the desired cost-neutrality, Namaf proposed and effected a reduction of 18,5 per cent on classified medicines and services.Further, the medical aid association proposed to private hospitals that an independent auditing team to reconcile unfair gains as well as losses be set up comprising members from both associations.That could not materialise and to the contrary Medi-Clinic proposed the new system.”Namaf said it remained prepared to enter into honest and transparent dialogue with Medi-Clinic.”The effect of the cancellation will mean that medical aid funds will no longer deal directly with Medi-Clinic Group,” said André September.Speaking at a press briefing, September said the healthcare industry was a critical sector that could not be left open to manipulation.In the event that members of private medical aid funds prefer utilising the facilities of Medi-Clinic, Namaf said, they should be prepared to pay the deposit as determined by Medi-Clinic.”In addition, the funds will reimburse the member upon producing an invoice in accordance with the benchmark tariffs and the fund rules.The members, in turn, will have to settle their accounts with Medi-Clinic.”However, Namaf said it would not reimburse the deposit, which falls outside the tariff regime.Members of the public were advised to utilise other private hospitals aligned with Namaf tariff structures, namely Rhino Park, the Roman Catholic Hospital, Welwitschia and the Tsumeb Private Hospital.The Namaf boss said the decision to cancel the guarantee payment system was meant to be in the interest of medical scheme members.September said the country could not rely on monopolies in an industry as important as healthcare.The Namaf decision followed Medi-Clinic’s insistence that medical aid fund members pay an 18,5 per cent deposit upfront before hospitalisation.For instance, a pregnant woman has to pay a deposit of N$2 600 for a Caesarean and about N$1 550 for a normal delivery.September explained that the dispute with Medi-Clinic arose from the 2005 tariff structure that Peter Sanders, then chairman of the Namibian Association of Private Hospitals (NAPH), proposed to Namaf last year.”In light of the prevailing insecurities at the time regarding the cost of medicine, the private hospitals agreed to remove all margins from ethicals and surgicals and provide medicine at the South African single-exit price.After deliberations on the tariff structure, Namaf agreed to the pricing system with room for adjustments.Namaf however alleged that after a recent assessment, hospitals as an industry were benefiting from higher tariffs on one hand while on the other they were not able to provide medicine at a cost that could balance the impact of the increases.The result was a skewed and unfair impact in favour of hospitals.”In line with our agreement and in order to create the desired cost-neutrality, Namaf proposed and effected a reduction of 18,5 per cent on classified medicines and services.Further, the medical aid association proposed to private hospitals that an independent auditing team to reconcile unfair gains as well as losses be set up comprising members from both associations.That could not materialise and to the contrary Medi-Clinic proposed the new system.”Namaf said it remained prepared to enter into honest and transparent dialogue with Medi-Clinic.