A new strategy as Clinical Governance Regulator (2024 AGM) was announced by the Namibian Association of Medical Aid Funds (Namaf).
This preposterous announcement poses the question: How is it possible that an association of funds, responsible for self-regulating their market conduct, can be allowed to morph into a self-proclaimed clinical governance regulator of the private healthcare industry.
When, why and how did this happen? Are the responsible parties going to allow it?
NUTS AND BOLTS
Namaf is an association of medical aid funds (MAFs). Their affairs are controlled by a management committee (MC).
All funds nominate representatives to form an electorate choosing the MC members among themselves.
The Medical Aid Funds Act 23 (1995) provides the framework within which Namaf and the MAFs operate; the purpose is “to provide for the control and promotion of MAFs; to establish the Namaf; and to provide for matters incidental thereto”.
As financial institutions, MAFs are regulated by the Namibia Financial Institutions Supervisory Authority (Namfisa). The medical aid act appoints the chief executive of Namfisa as the registrar of MAFs.
The act describes the purpose of Namaf as “to control, promote, encourage and co-ordinate the establishment, development and functioning of funds in Namibia”.
The association has a statutory duty to make rules that the management may take disciplinary steps against any registered fund.
Namaf’s regulatory function is the market conduct of funds.
It is to this end only that the association can make rules.
Namaf has no mandate to make rules which healthcare providers (HCP) must comply with or to regulate providers. That falls to the Ministry of Health and Social Services and the Health Professions Councils of Namibia.
QUALITY OF CARE
Clinical governance is a function exclusive to healthcare service providers (health care professionals and facilities).
It encompasses activities in which providers become involved in the maintenance and improvement of the quality of care provided and in ensuring accountability to patients.
The chairperson of Namaf opened his 2023 annual report by stating that the crisis in the health funding industry had tested Namaf’s regulatory powers to the core and “enabled Namaf to prepare for a new strategy that was set to redefine our path for the next three years as a Clinical Governance regulator”.
In contrast, the chairperson in 2018 reported: “Namaf is responsible for policy formulation and industry compliance in terms of Section 18 of the Act, which underpins the market conduct regulation identity of Namaf … the approval of draft rules and regulations marked a major milestone…”.
Note the fact that it took the association two decades to approve draft rules, which were never gazetted.
Market conduct of funds has always been and still is unregulated.
‘PROVIDER BEHAVIOUR’
These two reports show that morphing from a never-functioning market conduct regulator of funders into a self-proclaimed clinical governance regulator of providers happened recently.
Most Namaf reports for this period are accessible in the public domain.
On reading the reports, the answers to the “why and how did this happen?” are supplied by Namaf themselves and should be further analysed.
The funding industry uses the term ‘provider behaviour management’ for interfering with clinical decisionmaking.
This activity will lead to their financial gain to keep their lucrative industry afloat.
The price is exposure of members to clinical decisionmaking based on the interest of the funding industry.
The funds and Namaf do not seem to consider this strategy unethical.
THE MAIN DUTY
Since Hippocratic times, the provision of healthcare has been based on the ethical principle that the interest of the vulnerable patient is the clinician’s main duty.
Never may a decision be influenced by what is beneficial to the provider or any third party. This will be considered a punishable ethical transgression.
Providers cannot accept Namaf’s preposterous strategy which is potentially harmful to patients.
We have to ask the regulators of the private healthcare funding and service provision industry “Why are you allowing this to happen?”
* Sophia van Rooyen is a proud provider, registered family physician, member of MAN and director of the Namibia Private Practitioner Forum (NPPF).
Stay informed with The Namibian – your source for credible journalism. Get in-depth reporting and opinions for
only N$85 a month. Invest in journalism, invest in democracy –
Subscribe Now!
