The Namibian Association of Medical Aid Funds (NAMAF) says the country’s healthcare funding industry is pulling together to address the sustainability concerns of the sector.
This comes as in November 2023, NAMAF announced that the N$5 billion medical aid funding industry is under financial pressure with utilisation as the root cause.
“NAMAF has put in place a robust stakeholder strategy that is aimed at bringing all parties to the table to create solutions that are beneficial to all parties. Therefore the establishment of the Healthcare Provider Working Group and Healthcare Provider Forum will ensure that a range of functional expertise from a healthcare provider and create an opportunity for a broad range of ideas, considerations, and compromises to be worked out as early as possible to avoid costly errors, rework, and miscommunication,” NAMAF’s Corporate Affairs Specialist Uatavi Mbai said on Friday.
Medical aids have been found paying more for health care services as opposed to what members contribute to fund, resulting in funders (medical aids) digging deep into their reserves to cover the shortfall.
This move comes as hospitals, medicine, and specialist services collectively account for approximately 31%, 16.7%, and 11.4% of the highest cost drivers for medical aid funds, respectively.
“On obtaining greater visibility on the 2023 claims experience, contributions are approximately 10% lower than total expenditure, shortfall is being funded from reserves according to the NAMFISA quarterly reports. Based on this data, the Management Committee of Namaf thus resolved not to increase the Namaf benchmark Tariff for 2024,” said Mbai.
Effective 1 January 2025, NAMAF plans to enforce stricter guidelines, mandating that all medical claims indicate the diagnosis using the International Classification of Disease (ICD) 10 codes. With this, the association aims to achieve a utilisation rate of 70% by closely monitoring adoption rates and offering training programs to ensure compliance.
“We are already starting to see efficiency emerging from the strategies that have been implemented by the industry and will closely monitor the implementation of the strategies put in place. The industry collectively will continue to address the waste and abuse in the healthcare system by continuing with stricter applications of billing rules and guidelines, amongst other strategies that would be put in place,” said Mbai.
