Windhoek-The Public Service Employees Medical Aid Scheme (Psemas) is being revamped to make it sustainable and less susceptible to fraudulent claims, the Ministry of Health and Social Services said on Monday.
According to media reports, Psemas has been turned into a milking cow by some unscrupulous private doctors who submit suspect claims.
And public servants in need of medical attention have to pay their bills from their own pockets and claim back later from their medical aid, as most health professionals in the country still refuse to service them if they don’t pay due to long payment delays by Psemas.
At a press conference on Monday the health minister Dr Bernard Haufiku and health permanent secretary Andreas Mwoombola said the governing structure of Psemas is undergoing a revamp.
“Very soon we will see a different model of Psemas. A completely different one from what we have been experiencing,” said Haufiku.
Mwoombola said the overhaul would deal with the whole Psemas structure. This would include doctors registering to practise and registering a medical practice.
“Those things are not coordinated around one point and it’s difficult to pick up where the root of the problem is,” stated Mwoombola.
“We need to know that if there is a claim of a lady who gave birth, it’s really a lady who gave birth and not a boy who claimed to give birth. All those things need to be managed and controlled properly for the sake of sustainability of the fund. Currently the fund is not sustainable and it’s open to abuse from service providers as well as those who receive the service,” added Mwoombola.
Meanwhile, Haufiku said he was concerned about the state of Psemas and that he had proposed better mechanisms since 2006. “We have seen that things are not well with Psemas
”He said the bad media publicity, amongst others, forced the Ministry of Finance to take a bold decision to address the problem. “The Ministry of Finance did an audit to catch out the culprits and investigations are at an advanced stage – results would come very soon,” said Haufiku
Doctors, nurses, pharmacists and private hospitals would be paid and currently 50 percent of them have been paid by Psemas, said Haufiku. One such company is Namibian Wholesale Pharmaceutical Distributor (Nampharm) that according to a report by the Confidente newspaper was owed N$133 million. The newspaper also reported that a massive shortage of drugs looms in the country. Nampharm reportedly revealed that it was no longer able to import drugs unless it was paid its dues by the government and private health institutions.
“We have taken a decision that we would pay 50 percent of them before the end of March – all the people owed by Psemas – and the rest in April,” said Haufiku.
“Nampharm that was owed N$ 133 million has already been paid. There is no reason to panic. Obviously things haven’t been well – we need to admit that the Psemas scheme with the billions that we put in hasn’t been managed well,” said the health minister.
He added: “I think we left it to the doctors, to make them gatekeepers, and it didn’t work.”
On the scheme’s options, Haufiku said: “I don’t know why they changed the options.” The scheme has low and high options.
“My own idea eight years ago was that the funds that we put in Psemas must be used to upgrade state facilities to the level of private hospitals and make sure Psemas patients come to public infrastructure,” said Haufiku.