By:Nghiinomenwa-vali Erastus
About 82% of the country’s estimated 2,5 million population are at the mercy of the public health system as they are not medically covered.
The latest medical insurance coverage shows that only 441,777 are benefiting from medical coverage in the country, in both the public and private sectors.
This means that 17% have access to diversified health services, specialists, short queues, and various medical technologies that in many cases are missing from public health facilities.
The medical coverage privilege has also come at a cost.
Those who are medically covered by the private sector contributed N$1.2 billion for the quarter ended 31 December 2022, as for the government it allocated N$2,7 billion for 12 months.
The 82% of the population have, however, access to 424 public and mission health facilities across the country of which 322 are clinics.
Of the total medically covered, 232,000 are beneficiaries of the government Public Servants Medical Services.
The Namibia Financial Institutions Supervisory Authority’’s (Namfisa) latest quarterly report indicated that private medical aid has covered 209,777 beneficiaries as at 31 December 2022.
Total membership increased by 1.1% quarter-on-quarter and by 2.5% year-on-year.
Notably, the increase in beneficiaries is dominated by pensioners who increased by 1.5% during the quarter under review and by 4.7% on an annual basis.
Namfisa explained that the sustained annual increase in pensioner members may present higher claims risks for the industry as older members generally claim more than younger members.
Therefore, enrolling younger and healthier beneficiaries at a higher rate than pensioner beneficiaries would be beneficial to the industry as it would contribute to the long-term sustainability of the industry, Namfisa pointed out.
Total contributions by the medically covered increased by 1.0% to N$1.2 billion for the quarter ended 31 December 2022 and grew by 7.1% on an annual basis.
As for the membership in the private sector it grew by 1.1% during the quarter under review, which was in line with the change in contributions reported during the quarter under review.
Average contribution income per beneficiary was N$5,892 for the quarter ended 31 December 2022, a slight decrease of 0.1% quarter-on-quarter and an increase of 4.6% year-on-year.
The average claims per beneficiary decreased by 10.0% quarter-on-quarter and increased by 7.0% year-on-year, to N$5 281.
The industry dependency/medical aid ratio stands at 1.23 as at 30 September 2022- the ratio means that on average for every 100 principal members, there are roughly 123 dependents, which ratio remained unchanged quarter-on-quarter and year-on-year.
In terms of subsidising across different income levels, closed medical fund principal members receive higher contribution subsidies than open fund members and can therefore afford to enrol more dependents.
The proportion of pensioners to total beneficiaries was 6.3% as at 31 December 2022, unchanged from the pensioner ratio reported as at 30 September 2022, but slightly higher than the 6.2 % reported as at 31 December 2021.
The open funds’ pensioner ratio was 6.2% while that of closed funds was 7.7 %.
The higher ratio for closed funds is expected due to the high proportion of continuation members within the closed medical aid funds8 sub-industry.
The report has also indicated that the medical aid industry’s healthcare expenditure (claims) decreased by 9% to N$1,1 billion during the fourth quarter of 2022 and increased by 9.6% year-on-year.
Trends have shown that members’ claims behaviour reflected that claims rose during the first quarter of 2022, reached a peak during the second and third quarters, before dropping off during the fourth quarter due to depleted benefits by the end of the benefit year.
Hospital costs and pharmacies have taken up a chunk of health expenditure.
The annual healthcare cost inflation is higher than the annual contribution increases hence the higher claims ratio reported for the current quarter compared to the claims ratio for the corresponding quarter in 2021.
The industry incurred non-healthcare expenses amounting to N$135.8 million during the quarter ended 31 December 2022, representing an increase of 5.9% from the previous quarter, and an increase of 9.5% on an annual basis.
Non-healthcare expenditure incurred by medical aid funds consists of administration costs, managed healthcare costs (fees for managing health benefits), operational expenditure and net-reinsurance expenditure.
Administration costs remained the highest contributor to total non-healthcare expenditures.Email: erastus@thevillager.com.na
