The annual 2018/19 budget tabled by the Minister of Finance, Calle Schleitwein, on March 8, 2018, allocated N$2.5 billion to the Public Service Employees Medical Aid Scheme (PSEMAS), which has, as its objective, ‘to assist its members with the cost of medical care’.
However, PSEMAS, as a medical aid scheme for public service employees, has been lacking in this very regard, with medical practitioners refusing to treat its members without an upfront cash payment to be reimbursed at a later date because of failure by its administrator, Methealth to honour its contractual agreement and pay these medical practitioners on time for services provided.
The member-PSEMAS-Methealth-health practitioner arrangement is one that has raised eyebrows over the years and has received prominence in the media due to the negative effects on most, if not all, of its value chain members, which begs the question of why the value chain actually exists and what other options there are to make it shorter and more responsive to those who it is intended to serve.
The current set up sees Methealth, as the administrator, playing the role of a middleman in administering a fund, which raises the question of why the Ministry of Finance does not explore the viability of making PSEMAS a fully fledged parastatal servicing its clients at both ends of the value chain, namely, its members and health practitioners.
Methealth, among others, is responsible for the processing, authorisation, paying out and auditing of claims by its clients, namely health practitioners. A job with roughly an 180-day waiting period, which often lasts longer as health practitioners often complain that their claims for payment can take periods of up to 15 months to get settled while other practitioners have their claims paid in less than 60 days.
There is anecdotal evidence that suggests favouritism in the payment of claims with those who have connections and friendly relationships with Methealth receiving priority. However, healthcare providers who have been experiencing these shortcomings are not willing to go on record to address the issue for fear of victimisation and future delayed payments.
Methealth states, as one of its objectives, ‘access to affordable healthcare for Namibians’, which is an objective they have not been realising and have undermined PSEMAS patients whom they are supposed to service all along. The relationship between Methealth and its clients has gone sour over the years and health practitioners have complained time and again that they suffer irreparable damage with their own suppliers when their overdue accounts from Methealth are not settled timeously, which means they in turn cannot pay their suppliers on time, cannot meet their obligations with regards to their overhead costs and cannot plan for the future and invest in expanding their practices, a system which is not sustainable and has led to the closure of upcoming practitioners in the health field such as pharmacists who have had to close shop due to the above-mentioned.
Recent media reports state that PSEMAS has a staff complement of 30 individuals servicing about 100,000 members or approximately 300,000 beneficiaries. It stands to reason that the scheme itself, as a benefit to its members, is of outmost importance. However, it is when the scheme starts to become a target for systematic abuse by those who should be its caretakers or rather when the members of the scheme start to become quite on matters its members become disadvantaged.
Seven years ago, Windhoek-based specialists would be willing to see PSEMAS patients and would only require these patients to pay the 10 percent levy upfront. Today, those doctors are charging these same patients an upfront cash payment to be reimbursed by PSEMAS later. It is not the doctors who are at fault, neither should the blame be solely placed on PSEMAS, but the administrator Methealth, is not working in the best interest of the PSEMAS membership and it is the members who ultimately suffer.
– Vitalio Angula is a social activist and political commentator, who holds a Bachelor of Technology Degree in Marketing from the Namibia University of Science and Technology