Consultants to reform Psemas
2014 rates still applicable
08 November 2021 | Health
The finance ministry has decided to take a holistic approach to the various obstacles that plague the state's medical aid, Psemas.
Part of this approach is the appointment of a group of consultants led by Dr Johan van Zyl. Among others, the focus will be on the fund's rates, benefits and contribution structures, as well as the Psemas contract with service providers, which has been dragging on for several years without any changes.
In light of this, the ministry says it cannot comment on tariffs of the Namibian Association of Medical Aid Funds (Namaf) of 2014, which are still being used by service providers seven years later. The ministry said through its spokesperson, Wilson Shikoto, the reform process must first be completed before it can comment on this.
The team of consultants is expected to submit their report by the end of the year.
Shikoto referred to members of the Namibian Dental Association (NDA) who previously indicated that it is no longer viable for members to to treat patients at these rates and that they have to “pay in” for consultations. In light of this, the NDA said it will no longer treat Psemas members as from 1 November until the rates are increased.
Psemas members must therefore first for their consultations pay and then claim from the fund themselves.
Shikoto also referred to provision 10.6 of the standard terms and conditions of the Psemas contract that these service providers must comply with. He stressed that the ministry takes seriously the issues raised by the NDA and is focused on ensuring that the reform of Psemas will take place within set time frames.
“We therefore encourage service providers who have a contract with Psemas to treat members at the 2014 rates until the reform is completed,” Shikoto said.
He also referred to several discussions that have taken place with the NDA on various platforms over the past few months about raising standard rates. The Psemas reform aims to restructure the scheme for internal cost savings. An alternative model for service delivery as well as the controversial tariffs form part of this process.