Niël Terblanché
The Ministry of Finance and Public Enterprises has embarked on a comprehensive reform initiative of the Public Service Medical Aid Scheme (PSEMAS), resulting in the recovery of N$43 million.
According to Wilson Shikoto, the spokesperson of the Finance Ministry, PSEMAS has had unsustainable expenditure patterns over the years, prompting a need for structural changes to ensure its long-term viability.
“The unsustainable escalation of expenditures in recent years prompted the government to undertake a holistic reform effort,” Shikoto said in a statement.
He indicated that a consortium of consultants with extensive expertise in the industry was engaged to provide actuarial and technical consultancy, scrutinizing the benefits and contribution structure, PSEMAS tariffs, and overall governance and administration.
As part of the reform process, short and medium-term administrative changes were also implemented to mitigate risks.
According to Shikoto, these changes included a comprehensive membership re-registration to eliminate “ghost members,” an enhanced membership management system to reduce human error and fraud, and the introduction of SMS notifications for members’ claims to combat fraudulent activities.
He said the reform efforts have yielded substantial financial recoveries. Around N$13 million was recovered from irregular claims, including false representation, dishonest practices, abuse, and over-servicing by healthcare providers.
Additionally, over N$23 million was retrieved from members in arrears with the scheme, and N$7 million from retirees who failed to reapply post-retirement.
As part of the compliance audit, the Ministry engaged Deloitte Namibia in January 2023 to assess compliance with PSEMAS rules and benefit structures.
According to Shikoto, the final Compliance Audit Report, received in October 2023, included recommendations for improvements.
“While data discrepancies were identified between the Ministry of Education, Arts and Culture (MFPE) data system and that of Methealth Namibia Administrators, the Ministry is committed to investigating the source of these discrepancies and addressing them accordingly,” he said.
The Finance Ministry has affirmed its dedication to “fixing” PSEMAS and containing further wastage.
Shikoto also assured the public and PSEMAS members that individuals or entities found to have fraudulently benefited from the scheme will face legal consequences.
He said the structural reforms and administrative changes are expected to strengthen PSEMAS, ensuring its sustainability and continued support for civil servants and their families in need of medical care and services.
PSEMAS, established under Section 34(l)(d) of the Public Service Act, 1995, has been a vital benefit for civil servants, offering financial assistance for medical care and promoting member wellness through various programs.
With approximately 278,000 beneficiaries currently, the scheme plays a crucial role in providing medical, paramedical, dental, and other essential services to its members and their dependents.
