WINDHOEK - The Ministry of Finance yesterday engaged healthcare service providers on issues pertaining to the Public Service Employees Medical Aid Scheme (Psemas), with Minister of Finance, Calle Schlettwein, telling the well-attended event that the heavily subsidised government medical scheme needs to be saved. During the keynote address, Schlettwein said all stakeholders of the scheme need to find ways not to reduce service levels and member benefits while identifying ways to reduce cost, adding: “The cost drivers of the scheme are unsustainable.”
According to Schlettwein, Psemas is by far the best medical aid scheme in the country in terms of the level of coverage provided by members’ contributions but warned that the scheme is under severe threat from broad-based fraud. He noted that a peer review mechanism of the scheme has identified more than 80 cases of suspicious activity and said that a forensic audit of activities on the scheme is still ongoing.
The minister confirmed that through the peer review mechanism, which flagged service providers, including general health practitioners, dentists, hospitals, pharmacists and medical aid administrators, about N$13 million had already been recovered and that government expects to recover an additional N$23 million lost through fraudulent activities.
“Everyone had their hand in the kitty and all groups were guilty of irregularities … If we don’t contain this broad-based fraud then we will have to abandon the scheme,” Schlettwein warned.
He added that during the peer review exercise the number of claims actually dropped but escalated again when the mechanism was completed.
“We as stakeholders need to identify all the rotten apples and get rid of all of them … we as stakeholders and administrators have to enforce a zero tolerance in terms of illegal activity related to the Psemas,” said Schlettwein.
During the tabling of the national budget last Wednesday, Schlettwein announced that Psemas will receive N$2.8 billion for the 2019/20 financial year. Budget documents indicate that Psemas was allocated N$2.2 billion in 2016, N$2.5 billion in 2017, and N$2.5 billion in 2018.
Membership contributions for the scheme were N$120 for the main member and an additional N$60 for every dependant. However, the latest budget saw main member contribution rates increase by 100 percent, from N$120 to N$240 while coverage for dependants is now charged at N$120.