NHP apologises for transition chaos

The Namibia Health Plan’s (NHP) transition at the start of April to a new managed care arrangement at Universal Healthcare aims to strengthen the fund’s long-term sustainability, improve care management capabilities and oversight, and support the responsible use of contributions over time.

“The transition was the hardest step and also the step that forces the fund to become more resilient, transparent and clinically focused,” NHP principal officer Dantago Garosas said in a statement issued by the medical aid fund.

According to Garosas, the decision to transition from Medscheme to Universal Healthcare was taken through governance processes and with NHP’s long-term value and member outcomes in mind.

“We made this change to make sure the fund stays strong and can keep supporting members while also improving how healthcare is managed and delivered. These long-term benefits include cost savings and accountable reporting,” she added.

Garosas acknowledged the challenges that have affected the fund over the past month, including claims from service providers that were not processed.

She expressed sincere regret over the disruption in service delivery and shortcomings in communication during the transition.

Garosas also acknowledged that the implementation process fell materially short of the fund’s expected operational and communication standards.

“NHP acknowledges the significant frustration, inconvenience and uncertainty caused during this period and offers its sincere apology to all affected stakeholders.”

She stressed that NHP remains committed to sharing progress “honestly”, including where challenges still persist and until service levels have been fully restored.

Troubled rollout

In this regard, additional resources have been deployed and corrective measures implemented to stabilise operations.

According to her, the backlog of claims for April has been cleared and the vast majority of members’ claims are once again being processed within normal timeframes.

Garosas also acknowledged ongoing challenges, including the process for the pre-authorisation of medical procedures, which has not yet returned to previous service levels in all cases.

However, targeted interventions are in place, she said, including dedicated teams focusing on hospital admissions and clinical emergencies.

On behalf of the fund, she invited members and service providers to participate in stakeholder meetings on the designated platforms available, with meetings scheduled for 11 May.

Garosas said NHP remains focused on ensuring that members continue to receive their benefits in accordance with the fund’s registered rules.

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