Private sector to shun PSEMAS

PRIVATE healthcare providers will soon start rejecting patients on the government’s Public Service Employee Medical Aid Scheme (PSEMAS).

This is according to the Namibia Private Practitioners’ Forum (NPPF) – an organisation formed by private healthcare providers in the country.

The organisation, established in 2011, aims to bridge the gap between healthcare providers, medical aid funds and their administrators and governing bodies, the Competition Commission of Namibia, as well as government ministries and institutions.

In a press release last week, the NPPF’s risk adviser, Eben de Klerk, said about a third of private healthcare providers intend to stop treating Psemas members, and some who are contracted with the medical aid scheme will drastically reduce members of the government medical aid scheme under their care.

The NPPF charged that Psemas is notorious for late payments, and in certain instances, payments are not received. Additionally, there is the administrative burden of submitting claims, registration, and contract renewal procedures.

“Psemas rarely or never pays them within the contractually agreed 60-day period, and since healthcare providers purchase medical supplies and medicine, they often need to take up or extend credit facilities with their banks, on which loans they pay interest and administrative charges,” the statement read.

This makes running a private practice very difficult, and was exposing healthcare providers to substantial financial and sustainability risks.

“It is not only about making Psemas sustainable, but the service providers too. In some cases, private practices end up closing because of this,” De Klerk explained.

He said the tariffs for private healthcare providers were low, unmatched to inflation, and just “very unsustainable”.

The organisation has also warned that Psemas patients will soon start becoming second-rate patients, as healthcare providers begin to prefer treating private medical aid patients first in an attempt to keep their practices sustainable.

“Psemas was informed of this problematic situation in 2014 already, but nothing was done to address this sustainability risk the scheme is exposed to,” De Klerk added.

Furthermore, Psemas provides no official communication, and numerous enquiries on the deadline and several other technical problems regarding contract renewals, to the executive director of finance, remain unanswered.

“This adds to the frustration of those private sector healthcare providers who are still willing to treat Psemas patients,” he noted.

The government medical aid fund takes up about 65% of all medical aid coverage in the country, and has a budget allocation of N$2,4 billion for the current financial year.

At a healthcare stakeholders’ meeting last month, Psemas executive director Elizabeth Kharuchas told healthcare providers not to discriminate against Psemas patients as they are bound to treat them through the contracts they have with the medical aid scheme.

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