THE Ministry of Finance has extended its medical aid scheme administration contract with MetHealth Namibia Administrators to 31 March 2020, minister Calle Schlettwein says.
Methealth Namibia – a member of the MMI Holdings Group – has been administering the Public Service Employees Medical Aid Scheme (PSEMAS) since 2004.
Schlettwein told healthcare providers of the extension at a breakfast meeting attended by officials from the Office of the Prime Minister and the finance ministry and MetHealth representatives in Windhoek yesterday.
The breakfast meeting brought the healthcare stakeholders under one roof to discuss the overview of PSEMAS, educate health services providers on claims management and the payment process, as well as curb wastage, abuse and fraud within the fund.
The meeting also looked at ways to ensure the sustainability of the medical aid scheme.
Schlettwein said the fund was suffering fraudulent attacks from service providers, members, administrators and civil servants.
“Investigations have shown that everyone had a hand in the till. Therefore, we need to expose the rotten apples and get rid of them for the sustenance of the fund,” the minister stated.
Forensic investigations are underway and are nearly complete, and the culprits will be held accountable, Schlettwein said, adding that N$23 million is envisaged to be recovered, and N$13 million of this amount has already been recovered.
He warned that should the current trend of mismanagement and fraud continue, the sustainability of the scheme would be jeopardised, and that would affect the entire health sector.
Speaking at the same event, PSEMAS deputy director Elizabeth Kharuchas said the fund has been running deficits since 2016, with average yearly shortfalls of N$400 million. PSEMAS has about 297 000 beneficiaries, including about 5 000 pensioners.
Its budget amounts to N$8,5 billion over the four years from 2015 to 2019, with an additional N$1,7 billion to cover yearly shortfalls.
The fund was allocated N$2,4 billion in the 2019/20 budget.
Kharuchas said the largest chunk was spent on pharmacies, followed by hospitals and general practitioners. Dentists presented the lowest bill of about N$15 million between 2014 and 2019.
She said the PSEMAS reform unit in the Office of the Prime Minister is responsible for reviewing the fund’s benefits structure, and will propose a new structure and governance model that would ensure the fund’s sustainability as soon as they are through.
The Namibian understands that the reform unit is considering converting the state’s medical aid fund into another public enterprise, or a fully functional organ within the finance ministry, without having its administration outsourced.
Senior government officials accused the finance ministry for always shifting the blame over claims and fraudulent activities, and said the reason why costs have spiked over the years is due to an increase in the number of beneficiaries which the ministry failed to control and manage.
Some sources accused high-ranking officials responsible for the fund’s management of being incompetent, and of blocking developments that would bring the needed control to the fund. This has led to a cycle of frustration and compromised efficiency.
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Publish date : 2019-04-02 12:45:12