Psemas members’ crossover to public hospital looms

State employees will be required to use designated public hospitals – from 1 April this year - as part of sweeping reforms to the government’s medical aid fund, the Public Service Employees Medical Aid Scheme (Psemas).

Last year, President Netumbo Nandi-Ndaitwah directed that from April 2026, all senior government officials and staff under Psemas will be required to use public health facilities, rather than opting for private care.

This is part of the 5-year, N$85.7 billion development plan, contained in the Swapo manifesto, aimed at upgrading public hospitals and health clinics in Namibia to match the standards of private facilities. 

A readiness assessment has already identified certain public health facilities as suitable for inclusion. The development was disclosed during a meeting between Psemas and a broad group of stakeholders in the private healthcare sector.

Under the proposed changes, public hospitals will begin submitting claims in a manner similar to private facilities. However, Psemas acknowledged a significant operational hurdle - the absence of a billing system capable of processing such claims.

A new contract for service providers is currently before the attorney-general for evaluation. In addition, the scheme may review its annual contract renewal cycle due to the administrative burden it places on staff.

Tariffs and benefit restrictions under review

The current tariff structure — based on a 2014 scale that has remained unchanged for more than a decade — will ultimately be reviewed as part of the reform process.

Psemas indicated that certain benefits will be limited, with additional restrictions expected, particularly regarding medication. Consideration is also being given to the establishment of a dedicated governing board comprising representatives from government, trade unions and private sector experts.

Meanwhile, frustration among private healthcare service providers has intensified. Claims for December and January, amounting to N$376 million, remain unpaid.

During the meeting, Psemas acknowledged that its expenditure for the current financial year has exceeded its approved budget. Some service providers are reportedly grappling with depleted medical supplies and mounting financial pressure, as the scheme’s last payment run occurred in mid-December.

According to Psemas, it has approached Treasury for additional funding “amid competing national priorities”. While acknowledging the strain placed on service providers, the fund maintains that the current situation is beyond its immediate control.

Several stakeholders criticised Psemas for failing to communicate timeously about the looming cash shortfall, arguing that the fund had been aware of the financial pressures well before December.

Rising costs and governance uncertainty

Psemas attributed its financial strain to “over-utilisation” but did not present stakeholders with a detailed analysis explaining the drivers behind the increased claims.

Claims rose by 14.8% in the 2024/25 financial year — significantly higher than the 1% to 4% annual increases recorded over the preceding five years.

The scheme currently spends approximately N$4 billion annually, with members contributing about N$500 million and taxpayers funding the remaining N$3.5 billion.

Cabinet is now considering the Social Security Commission (SSC) as a potential administrator for Psemas. This represents a shift from earlier discussions that had positioned the Association of Namibian Medical Aid Funds (Namaf) as a possible administrator.

However, private healthcare providers have questioned whether there is a statutory mandate for government to adopt Namaf’s standard tariffs, as is reportedly being contemplated.

The Namibia Private Practitioners Forum (NPPF) is currently developing an ethical tariff framework that could serve as a transparent alternative for future consideration.

Notably, no reference was made during the meeting to the potential impact of the Health Professions Council of Namibia’s (HPCNA) strategic objective to significantly increase the number of registered healthcare professionals by 2026. This is despite the absence of a clearly defined sustainability threshold for expanding the workforce within the private healthcare sector.