PSEMAS Medical Aid is in overdraft high care

HEALTH GATE WRITES:PSEMAS, the voluntary GRN civil servant medical benefit, is in deep trouble.The orange and red lights have been flashing for a number of years. Applying the same strategy and expecting a different outcome, reflects a lack of insight and competence.In mid-2020 the OPM/MoF set up a review committee on PSEMAS, as they realized it was unsustainable and a loss leader.PSEMAS is not a NAMAF registered medical aid fund, with checks and balances, a business plan and a reserve fund. It is an 85% benefit at an offered discount tariff to suppliers.Every year however treasury has to bail it out, like an SOE.It has plus/minus 245 000 members, dependents and pensioners. It has a claims budget of N$2.6 billion.The administrative function was outsourced by MoF and the Tender Board (Procurement Board).It has a standard (36%) and a higher (64%) option.On the higher option, the private hospital limit was removed a few years ago, without an actuarial projection analysis. This bottomless pit sunk PSEMAS in the Corona era. By mid-February 2021 funds were exhausted, with the end of financial year being 31 March 2021.The member contribution fees have been fixed, despite medical inflation since 2013/14. NAPWU opposed any increase before the last general election.There is no sliding scale. The contribution for a clerk to minister is the same. Is this equitable?Politicians and senior civil servants exert pressure for more benefits on deviations.The GP consultation fee is set at NAMAF 2014 tariffs, a 46% discount on the 2021 tariffs!The result is that many practices have opted out of PSEMAS, as they have to charge higher fees for a viable practice and good service. To make up for the lower fee, some resort to conveyor belt, high turnover, over servicing strategies. An example is three to five minute consultations, instead of average 10-15 minute consultations, resulting in a lower standard of service.• Fraud: members collude with non-members/friends to gain services on their membership card• No working diagnosis, unnecessary laboratory tests.• More, short follow-up consultations• Self-dispensing loaded scripts• More sick leave “reward”• 5% Co-payment, not charged, to encourage more visitsIn this scenario, there is no time for promotion of health, prevention of disease, screening, restoration, rehabilitation and palliation. Time is money.In 1990 the “A” team of MoHSS, Dr. Nicky Iyambo (Minister) and Dr. Solly Amadhila (PS) set a new course for pro-active Primary Health Care. Much was achieved but momentum was lost. Red flags remain.The challenge at independence was ignorance, poverty and disease (often said by the Founding Father).Your single most important investment in life is your health. Add education and skills and you become more productive and independent.The big three, slavery, addictive trade and the bartering tools of colonialism, still affect us today.• Tobacco (warning and heavily sin taxed)• Alcohol (warning and heavily sin taxed)• Sugar (no. 1 addiction worldwide not taxed!?)The "Ministry of Votes" feared a loss in support at the polls if sugar was taxed with VAT, despite this being announced by the Minister of Finance, Mr. Calle Schletwein in his additional budget in March 2020. The long-term collateral damage of fast, fake, sugar and salt junk foods are massive.• Obesity, diabetes, hypertension and corona deaths• Osteoarthritis, reflux, snoring• Cancer and infertility• Early retirement and death• Cost of treatment• Loss of productionThink of the next generation, starting with the ANC (Antenatal Clinical) school and not the next election (votes). Think Vision 2030, prosperity, health and happiness.If professional, non-political Namibians put their common sense and scientific heads together, PSEMAS can be transformed from a milk cow to an agent for change, for the common good.Health is wealth. If you receive a benefit, you have an obligation, in return, to lead a healthy lifestyle.PSEMAS/MoF, the taxpayer cannot afford to waste money by subsidizing treatment of bad, reckless death style habits.It is desirable to have a healthy mind in a healthy body. Movement of mind and body is life, keep moving, and live. Stay healthy and become a winner.Employ science, transparency, accountability, justice and partnership. Don’t pretend to be a socialist and a role model and then revert to George Orwell’s Animal farm, believing that some VIP animals are more equal than others. The people you elect to serve you, are more equal than the people they serve.Yet, speaking truth to power is dismissed.

PSEMAS Medical Aid is in overdraft high care

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Republikein 2025-04-07

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PSEMAS Medical Aid is in overdraft high care

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