New Medical Aid for Lower Income

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By Staff reporter WINDHOEK The Namibia Health Plan (NHP), the second largest private medical aid fund, has since the beginning of the year embarked on measures to make health care more affordable to all people. In a country whose workforce is hard hit by the HIV/AIDS pandemic, the medical aid fund notes that it has become important to develop a product that provides affordable yet comprehensive medical aid treatment to people that are most affected yet cannot afford the luxury of expensive medical aid. As of January 1, this year, NHP has been providing the Blue Diamond low cost benefit option as a way of introducing lasting and affordable solutions to healthcare provision and financing in Namibia. It is aimed at providing primary health care services to the lower income groups who previously were marginalized and did not have access to subsidized private healthcare. The option provides unlimited cover for hospital and surgical admissions and treatment at the private wings of state hospitals. It also provides unlimited cover in respect of day-to-day medical services subject to the provision that members will be restricted to making use of the facilities of the network service provider only. NHP Medical Aid Fund Chairperson, Peter HerlÃÆ’Æ‘Æ‘ÃÆ”šÃ‚©, said in a statement yesterday the medical aid fund investigated and pursued the initiative because it was the right thing to do from a moral and social perspective. “The NHP medical aid fund believes not only in making access to privately subsidised healthcare more affordable to a large segment of the previously uninsured market, but also that meaningful and value added benefits are provided to its members,” HerlÃÆ’Æ‘Æ‘ÃÆ”šÃ‚© said. The medical aid fund collaborated with its administrator, Medscheme Namibia (Pty) Ltd, and identified the challenge to make access to private healthcare more readily available to a larger portion of the economically active population. It has been working closely with Diamond Health Services in developing an alternative healthcare model whereby some of the financial and clinical risk is transferred from a third party onto a provider of care through a capitated service arrangement. “The capitated service model has as its theoretical background the concept whereby risk is transferred from the medical aid fund to the service provider, in this case being the network of primary healthcare clinics, thus aligning cost saving objectives and incentives of the medical aid fund with those of the medical service provider,” a statement from NHP said. This also provides a sustainable answer to many employer groups where a large proportion of their employees previously declined medical aid cover or who simply resigned from their existing medical aid funds because their membership became expensive. Already, the initial uptake of the product in the first two months of its existence has been in excess of 300 members. Tiaan Serfontein, Medscheme Managing Director said the network of primary healthcare clinics would be expanded as the membership grows. To enable more Namibians to access more affordable healthcare, Serfontein urged employers to support the initiative. Meanwhile, NHP has also entered into an agreement with the Dutch PharmAccess Foundation, a foreign donor organization regarding making funds available to subsidise monthly healthcare contributions in particular the HIV/AIDS component. Both the NHP Blue Diamond Option and the NHP Economic Option qualify for a monthly subsidy in respect of each beneficiary per family.