Schlettwein satisfied with new PSEMAS model
Finance minister Calle Schlettwein believes the government and medical service providers have found a lasting solution to the problems plaguing the medical aid fund for public servants, PSEMAS.
“The new system has been developed by the government and various ministries together with the medical fraternity. We now have a workable instrument. We have also agreed to further cooperation to solve problems in the medium to long term,” said Schlettwein.
The future of PSEMAS needed to be protected as it accounted for 60% of the income of private medical service providers in Namibia, the minister stressed.
“PSEMAS must be viable to support government employees. We want to play our role in ensuring sustainability. PSEMAS funds 60% of medical services. It is the locomotive of the health services in the country. If we lose that one, we have lost a large chunk of what makes healthcare sustainable,” Schlettwein said.
He said several loopholes were closed, while the claims process was streamlined.
“We have closed the loophole of multiple medical practices under one medical licence in instances where doctors would charge consultation fees from various medical practices without even consulting,” Schlettwein said. When asked whether payments to PSEMAS would be cost-reflective, as is the case with private medical aid funds, Schlettwein explained that the government had an obligation to provide for the medical expenses of all its employees. “PSEMAS is a pay-as-your-earn scheme, it is state budgeted for and part of the conditions to provide medical services to all government employees. We are looking at how we can make it more sustainable,” the minister said.
“We felt strongly that every civil servant must get the same medical service. The scheme should not discriminate. You should get the same benefits across the board, from the minister to the cleaner,” Schlettwein said.
The backlog of overdue payments to medical service providers was cleared and payment is now made within 30 days of services being offered.
“We have caught up with the legal framework of paying within 30 days,” Schlettwein said.
Thirty service providers were blacklisted while five remain under scrutiny, it was announced at the press briefing.
Namibian Sun reported in March that 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 had been advised to urgently appoint a board of trustees to manage the fund effectively.
However, in the same year, Methealth was awarded a new five-year tender to continue administering the PSEMAS scheme, processing claims and making payments.
That tender has since been renewed annually. Methealth has been administrating PSEMAS since a merger with NamHealth in September 2003.
OGONE TLHAGE
“The new system has been developed by the government and various ministries together with the medical fraternity. We now have a workable instrument. We have also agreed to further cooperation to solve problems in the medium to long term,” said Schlettwein.
The future of PSEMAS needed to be protected as it accounted for 60% of the income of private medical service providers in Namibia, the minister stressed.
“PSEMAS must be viable to support government employees. We want to play our role in ensuring sustainability. PSEMAS funds 60% of medical services. It is the locomotive of the health services in the country. If we lose that one, we have lost a large chunk of what makes healthcare sustainable,” Schlettwein said.
He said several loopholes were closed, while the claims process was streamlined.
“We have closed the loophole of multiple medical practices under one medical licence in instances where doctors would charge consultation fees from various medical practices without even consulting,” Schlettwein said. When asked whether payments to PSEMAS would be cost-reflective, as is the case with private medical aid funds, Schlettwein explained that the government had an obligation to provide for the medical expenses of all its employees. “PSEMAS is a pay-as-your-earn scheme, it is state budgeted for and part of the conditions to provide medical services to all government employees. We are looking at how we can make it more sustainable,” the minister said.
“We felt strongly that every civil servant must get the same medical service. The scheme should not discriminate. You should get the same benefits across the board, from the minister to the cleaner,” Schlettwein said.
The backlog of overdue payments to medical service providers was cleared and payment is now made within 30 days of services being offered.
“We have caught up with the legal framework of paying within 30 days,” Schlettwein said.
Thirty service providers were blacklisted while five remain under scrutiny, it was announced at the press briefing.
Namibian Sun reported in March that 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 had been advised to urgently appoint a board of trustees to manage the fund effectively.
However, in the same year, Methealth was awarded a new five-year tender to continue administering the PSEMAS scheme, processing claims and making payments.
That tender has since been renewed annually. Methealth has been administrating PSEMAS since a merger with NamHealth in September 2003.
OGONE TLHAGE
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