Government has approved new rules to change how public hospitals charge medical aid patients, in a move aimed at improving billing, reducing losses and stabilising the public health system.
Information and Communication Technology Minister Emma Theofelus said Cabinet has agreed to align fees charged by the Ministry of Health and Social Services with those used by the Public Service Employees Medical Aid Scheme and the Namibia Association of Medical Aid Funds.
Public hospitals will now use a standard pricing system when treating patients with medical aid.
“Cabinet took note of the proposed implementation approach to align the Ministry of Health and Social Services tariffs to PSEMAS and NAMAF to ensure effective revenue management, improved administrative coordination with medical aid schemes, and long-term financial sustainability of public health facilities,” Theofelus said.
Under the new system, hospitals will charge based on NAMAF’s 2017 tariff rates, plus an extra 20%.
“Additionally, Cabinet approved that the proposed tariff rates set at 2017 NAMAF tariffs plus 20% for the purpose of billing PSEMAS and other medical aid fund beneficiaries utilising public health facilities and services,” she said.
The changes come as government pushes ahead with major reforms to PSEMAS, which covers civil servants.
From 1 April 2026, state employees are required to use public hospitals instead of private ones, following a directive by President Netumbo Nandi-Ndaitwah.
The aim is to cut costs and improve public healthcare, while reducing the heavy financial burden on the scheme.
PSEMAS currently costs around N$4 billion a year. Members contribute about N$500 million, while taxpayers cover the remaining N$3.5 billion.
Government plans to upgrade public hospitals and clinics under a five-year N$85.7 billion development plan so they can handle more patients and offer better services.
However, there are still challenges. Public hospitals are expected to start submitting claims like private hospitals, but PSEMAS has warned that the current system is not yet fully ready to process these claims.
Despite this, government is pressing ahead, arguing that fixing billing and forcing greater use of public facilities is key to making the system sustainable.
