Govt allays fears on medical aid

Medical professionals have been advised not to demand upfront cash payments from patients that are currently using government's Public Service Employees Medical Aid Scheme (Psemas). This comes off the back of rumours that the medical aid scheme can no longer afford to make payments.The request was made by ministry of finance permanent secretary Ericah Shafudah yesterday who said the medical aid scheme was undergoing a business re-engineering process.According to her, existing contracts for health professionals are currently being revised after it was discovered that the scheme had come under abuse by some medical aid professionals whom she said are aware of loopholes which allow them to cheat the medical aid scheme out of millions. Investigations are underway in this regard.“No Psemas-contracted health professional will require Psemas patients to pay upfront. If they do, the ministry of finance should be informed immediately. In fact, we urge the health professionals to desist from such,” said Shafudah.A review to the medical aid scheme was recommended as far back as 2010 Namibian Sun reported recently.A report in possession of Namibian Sun indicated the finance ministry knew as far back as April 2010 that there were major gaps in the fraud management system regarding claims managed by the fund administrator, Methealth. It had also received a list of suspect doctors, clinics and pharmacies that had submitted questionable and false claims, along with risk analyses. The ministry was also advised to urgently appoint a board of trustees to manage the fund effectively.However, in the same year, Methealth Administrators was awarded a new five-year tender to continue administering the medical aid scheme and doing the claims processing and payouts. That tender has since been extended annually. Methealth has been administrating Psemas since a merger with NamHealth in September 2003.According to Shafudah, Psemas members and their dependents would be covered, dispelling any fears that the scheme would not able to meet its obligations. “The ministry of finance would like to take this opportunity to set the record straight and assure Psemas members and their dependents that the scheme will continue to operate as it has been for all the years,” said Shafudah.She said a review of the contracts were necessary, owing to the country's precarious financial position. “The public will be informed of new changes to the contracts once the review process is finalised, ensuring that Psemas exists sustainably. Namibia is experiencing a tough financial period and all healthcare professionals and Psemas members and dependents need to adapt to the times.”In a recent interview with this paper, finance minister Calle Schlettwein said an investigation into the affairs of the medical aid scheme would be completed by the end of July. He added that if criminal activity can be shown, charges would be brought against medical professionals that are guilty of this conduct.Explaining the need behind the remodelling, would look at contributions to the scheme as well as the overall administration of the scheme. “We are looking for anomalies and trying to locate wrongdoing,” the minister said, adding, “Remodelling will include looking at contributions, benefits and the administration of the fund, as well as the roles of stakeholders and contracts with service providers.” STAFF REPORTER

Govt allays fears on medical aid

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Namibian Sun 2025-07-01

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Govt allays fears on medical aid

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Namibian Sun 2025-07-01

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