80% of Namibians without medical aid

About 80% of Namibians have no medical insurance cover, either from the state or private companies.

With a population of about 2.5 million people, the latest statistics show that only 490 229 people in Namibia have medical aid coverage.

Of these, 196 276 are covered by private companies. The public service medical aid fund, PSEMAS, covers the healthcare bills of at least 293 953 people.

The rest of the population either have to pay cash for private healthcare or are dependent on government health facilities. In total, more than 2.2 million Namibians do not have any form of health insurance.

According to statistics provided by the Namibian Association of Medical Aid Funds (Namaf) in its annual report for 2017, it paid out claims totalling N$3.14 billion last year, of which the bulk was for hospital expenses. All private medical aid funds must be affiliated to Namaf.

The report says the number of people covered by private medical aid funds had been growing steadily since 2014, when they had 173 526 beneficiaries.

The number of female beneficiaries has been growing at a faster rate than the number of males.

In 2014 there were 84 815 female beneficiaries, increasing to 97 259 by last year, while for men the number increased from 88 710 to 99 016 during that period.

While the average age of beneficiaries has remained constant at 29 years over the past four years, it is worth noting that fewer than 4% are pensioners older than 65.

The report states that the total value of claims received had increased from N$2.69 billion in 2014 to N$3.64 billion last year, while the value of claims paid out had increased from N$2.33 billion in 2014 to N$3.14 billion in 2017.

Of the benefits paid in 2017, hospitals accounted for 34% of the claims, medicines for 17%, medical specialists for 12% and general practitioners for 10%.

The report says the value of claims received from hospitals and related facilities had increased from N$0.81 billion in 2014 to N$1.11 billion in 2017, while claims paid to hospitals increased from N$0.78 billion to N$1.08 billion over the same period.

“Just less than a third of beneficiaries who were hospitalised were hospitalised more than once in a given year,” it states.

The value of claims received from pharmacies increased from N$0.53 billion in 2014 to N$0.72 billion in 2017 and the claims paid to pharmacies increased from N$0.42 billion to N$0.54 billion over the same period.

The report warns that high annual increases in medical aid contributions could make healthcare unaffordable.

“The impact of the high annual increases in contributions, coupled with the high increases in out-of-pocket expenditure, will have a negative impact on the access to and the affordability of healthcare going forward,” it warns.

The fund's chairperson, Benny Amuenje, says the change of Namaf's reporting line from the health ministry to the finance ministry remains a challenge.

“This was problematic, since Namaf regulates the conduct of medical aid funds, which relates to health and not finance, and it created role confusion between Namfisa as registrar and financial regulator and Namaf as market conduct regulator.”

Since its inception in 1997, Namaf has been operating without a strategic plan. Although a strategic plan, intended for the period of 2012 to 2016, was developed in 2010/2011, it was never rolled out. Therefore, a major milestone during the reporting period was the development of the Namaf Strategic Plan 2018 to 2020.

ELLANIE SMIT