NAMAF TRUSTEE TRAINING

18 & 19 AUGUST 2014 FACTS & FIGURES

CHIEF EXECUTIVE OFFICER SAFARI HOTEL WINDHOEK NAMIBIA

Current NAMAF Management (MC) for 2014

Mr. Benny Amuenje – Renaissance Health (President) Ms. Alison Begley – NMC (Vice President) Mr. Gabriel Tjombe – Renaissance Health (Treasurer) Mr. Gert Grobler – NAMMED: Chairperson

Affordability Committee Ms. Dolly Nashandih – NAPOTEL Mr. Danie Louw – NMC Ms. Glynis Labuschagne – NHP Mr. Desley Somseb – NAMDEB: Co-opted Ms. Elreen Austin – Woermann & Brock – Co-opted

The following Funds do not have representations on MC: BANKMED RCC

Current NAMAF Staff Compliment –2014

Mr. Gabriel Mbapaha: – Chief Executive Officer

Mr. Malakia Mateus: – Manager: Operations

Ms. Justina Nelulu: – Accountant

Ms. Rehetta Isaak: – Personal Assistant to the CEO

Ms. Ramona Mathupi: – Administrative Support Clerk

Mr. Thomas Tjituaiza: – Janitor

NAMAF Sub-Committees

In terms of the Medical Aid Funds Act, Act No 23 of 1995, NAMAF has the right to establish sub-committees in order to streamline its operations.

Affordability, Accessibility and Quality. Private Public Partnership. Capacity Building. Regulatory and Statutory Affairs.

VISION

 

To creatively engage all stakeholders in the

Namibian healthcare environment to providing

families of all income/ social economic groups

ongoing access to sustainable private healthcare

that is comprehensive and affordable.

          

To be the Statutory Representative Body (Endorsed and supported by all members/stakeholders) of the Healthcare Funding Industry.

Promoting equitable, affordable, accessible qualitative and value-adding services.

To be influential in policy making for the benefit of our existing and potential members.

To facilitate open discussions and debates with all stakeholders in the Namibian Healthcare environment.

Assuring the long-term sustainability of the Namibian Healthcare Funding Industry.

Mission

FACTS AND FIGURES

Total funds = 9 Closed Funds = 5 and Open Funds = 4 - estimated 80% of total members.

Open Funds: - NMC - NHP - Renaissance Health - Nammed

Closed Funds: - Bankmed - Napotel - RCC - Namdeb - Woermann & Brock

Membership Trends

Membership (families) have increased by 5.08% Beneficiaries have increased by 4.28%

Membership Trends - PSEMAS

Jan 2011- Dec 2011

95619 113902 7034 1.19 209521

Jan 2012- Dec 2012

100033 121033 6936 1.21 221066

Jan 2013- Dec 2013

103540 126708 6936 1.22 230248

Jan 2014 –June  2014

104055 128028 6936 1.23 232083

                                                                            

Total               Total     Total                Ave /Dep per      Members    Dependants      Pensioners      Members            Lives

Total membership have increased by 3.51%Beneficiaries have increased by 4.69%

Healthcare Dollar

Hospitals account for a third of the healthcare expenditure Pharmacies and general practitioners account for about another

one eighth each

Open and Closed Funds

Cost movements

Highest increases have taken place for hospitals, optometrists, medicines and “other” “Other” is off a low base Optometry could be due to two year cycle Medicines could (in part) be due to change in dispensing legislation (GP costs have grown slowly) Hospitals give cause for concern

Proportion of Medicines Paid

Members are faced with approximately 20% co-payments on medicines

Co-payments are similar for ethical and generic medicines

Generic Ratio’s

Generic ratio’s are remaining constant over time

NAMAF PROJECTS

NAMAF has embarked upon the following projects: Namibianisation of the Tariff Publication Alternative Dispensing fee Model NAMAF Centralized Data Repository NAMAF Practice Coding Numbering

System (PCNS)

Namibianisation of the NAMAF Benchmark Tariffs

Over the last five years NAMAF has developed unique processes whereby: Tariff codes and descriptors are updated in collaboration

with the various professional bodies Year on year increases in the benchmark tariffs are

calculated by using formulas that take into account objective facts with respect to increases in the underlying costs

Cost of equipment is calculated by using formulas that take into account aspects such as purchasing prices, cost of financing and maintenance costs

In short, NAMAF has over the last five years implemented  transparent process through which the year on year increases in the NAMAF benchmark tariffs are determined objectively.  This is a unique process and comes as a result of ground breaking work that has been done.

NAMAF Alternative Dispensing Fee Model

NAMAF has identified a need to develop an alternative dispensing fee model that will incentivise pharmacists to:

Provide patients with cost-effective medicines; and Increase the utilisation of generic medication

 

Central to the process is that:  The result should be cost neutral to the pharmacists as well

as the funds and The process should be participative and based upon

consensus Although a new model has not yet been implemented, good

progress has been made toward finding common ground and announcements will follow in the near future.

NAMAF Centralised Data Repository

NAMAF has commissioned the development of a centralised data repository that will allow for, for example:

Performing of comparisons against benchmarks; Understanding industry trends; Analysis of industry issues.

The first phase of development has been completed and individual funds have been given access in order for them to test their own data and provide feedback

NAMAF Practice Code Numbering System

It is NAMAF’s intention to develop its own practice code numbering system and to reduce its dependence upon the South African system.  This project will formally kick-off during the second half of 2014.

However, a provider database and lookup tool has already been incorporated in the centralised data repository and this will form the basis of the NAMAF practice code numbering system.

NAMAF FORUMS

NAMAF has implemented forums to foster good relationships and to tackle relevant matters at an appropriate forum. The forums are as follows:

Peer Review Forum Hospital Forum Administrators Forum

FIM BILL

The FIM Bill is currently with the legal drafters

Subsequently it will be referred to the Cabinet Committee on Legislation (CCL)

There is no definite date for implementation of the FIM Bill

STANDARDS & REGULATIONS

NAMFISA promised to consult the industry on the standards & regulations.

NAMFISA will discuss the standards & regulations first internally and than with the industry.

Industry consultations will be done via workshops.

COMPETITION COMMISSION ISSUES

The investigation of the industry by the Namibian Competition Commission (NCC) is still pending.

A number of submissions have been forwarded to NCC by our legal representative i.e.. Mr Hartmut Ruppel of LorentzAngula Inc.

NAMAF and the Funds were served with Form 6 Notices. According to NCC, NAMAF & the Funds contravened the

provisions of Part 1 of the Competition Act and mores specifically section 23(1) read with section 23(2).

The Commission considers approaching the Court under section 38 0f the Competition Act.

NAMAF is of the opinion that we are not an “undertaking” as per the Competition Act.

NAMAF believes that the Competition Act has no bearing on NAMAF as a statutory body.

Thank you