One step forwards, two steps backwards

Domestic worker Justine Khom-oabes used to spend many a day queuing at the out patient department of Katutura hospital. She now receives prompt attention at the private clinic around the corner, her employer having signed her up to NHP Blue Diamond – one of the new medical aid products targeting lower-income employees.
“It once took Justine three days to have a problem solved at the state hospital”, says Khom-oabes’ employer Sylvia Schlettwein, recalling why she decided to offer medical aid to her employee. “It’s good for Justine and its good for me to avoid long waiting hours at the hospital. In terms of productivity, there’s definitely been an improvement.”
Schlettwein pays Khom-oabes’ monthly medical aid premium of N$254, while Khom-oabes pays an additional N$156 per month to enrol her two children on the scheme. However, Khom-oabes, who earns N$1600 per month, cannot afford a further N$217 per month to enrol her husband, who continues to be treated through the state.
Both Khom-oabes and Schlettwein are at pains to point out that the domestic worker and her family do not have HIV, but took up the Blue Diamond scheme because of its general benefits. “Nonetheless, I’m happy the scheme has HIV and AIDS benefits should I ever need them”, says Khom-oabes.

Problems
The scheme has not been without its problems. Before hospital cover was included in the scheme, Khom-oabes needed a sonar. But the Diamond Health Services clinic in Windhoek did not have the equipment, so referred her to the state hospital. “When the nurses at the state hospital found out I had medical aid, they refused to help me”, says Khom-oabes. Since hospital benefits were added to Blue Diamond earlier this year, Khom-oabes has not needed hospital treatment, and is waiting to see if she will face similar problems in future.
Blue Diamond covers treatment in the private wings of state hospitals, prompting concerns that these facilities – which already cater for around 140,000 beneficiaries of the Public Service Employees Medical Aid Scheme – will be able to cope with increased demand from private medical aid schemes. Diamond Health Services director Dr David Uirab believes the private wings of state hospitals will have no problem treating people covered by Blue Diamond and other new medical aid packages.
Essential to the HIV and AIDS benefits provided by medical aid schemes is the concept of “managed care” – the monitoring and support of HIV-positive people to ensure that they are prescribed the right medication, and stick to the their treatment regime. Strict adherence to medication and regular check-ups are essential for ensuring that HIV-positive people requiring anti-retroviral therapy remain healthy, and thereby avoid costly hospitalisation.

Disease management
In an attempt to encourage HIV-positive people to register for their disease management programmes, medical aid schemes do not charge extra for managed care, and make the programmes out to be supportive and confidential. To benefit from HIV and AIDS cover, HIV-positive people have to register with their medical aid scheme’s disease management programme.
Martin, a cleaner at a Windhoek company, did not understand what his doctor was talking about when he was first prescribed anti-retroviral HIV and AIDS therapy. Martin asked his work colleagues to explain the prescription he had received from the doctor, and his colleagues realised he was being treated for AIDS.

Martin’s medical aid scheme, NMC, has since enrolled him on its disease management programme, and Martin appears happy with the service he receives. However, Martin cannot afford to include his wife and children on his medical aid.
David is also HIV-positive, and enrolled on Renaissance Health’s HIV disease management programme in January 2004. He heard nothing from the programme until June 2006 when, out of the blue, he received a letter from Health is Vital, informing him that he was due to go for a check up, and failure to attend may result in him being kicked off the scheme.
Unbeknown to David, Renaissance had incorporated the Health is Vital HIV and AIDS benefits into its existing medical aid packages, and had transferred all its HIV positive clients to My Health, which manages the Health is Vital scheme. At around the same time, David’s claims for hay fever medication were rejected, as they were not part of his HIV treatment regime – a glitch apparently caused by the transfer of Renaissance’s database to My Health’s new computer system.
Companies insight spoke to say the take-up of the new medical aid packages by lower-income employees has been slow. Since NHP and Health is Vital made presentations to Meatco in July, only two employees had enrolled with the schemes, says the company’s human resources officer, Willem Nanub. This is despite the company paying 50 percent of the workers’ monthly medical aid premiums.

Absenteeism
The company would like all workers have medical aid, and cover for HIV and AIDS treatment in particular. “We are having a tremendous problem around absenteeism,” says Nanub, who believes the problem may be a result either of HIV-related sickness, or “ill discipline”. As a result, Meatco is considering raising its medical aid contribution to between 80 and 100 percent in a bid to encourage workers to take out medical aid.  Meatco is also planning to launch an HIV and AIDS awareness programme. At present, Nanub says, just 25 percent of the company’s workforce of 1,200 people is on medical aid.
Ohlthaver and List is also experiencing high absenteeism, and has put all its 2,500 permanent staff on to the Health is Vital HIV and AIDS benefit package, says Berthold Mukuahima, the company’s director of human capital. A next step may be to subsidise lower-income workers’ premiums for primary health care schemes such as Blue Diamond and Vitality Day Care.
“I think these new schemes are a step in the right direction”, says Mukuahima. “If only the medical aid industry can stand together, and bring products to the market that are truly affordable. State health care facilities are overwhelmed and, from a private sector point of view, we have to respond.”

Overdue
Peter van Wyk, who heads the Namibian Business Coalition on AIDS (Nabcoa), believes the new medical aid products are “long overdue”, and it was now up to employers to start contributing to employee’s medical aid benefits.
“Many employers still say: ‘We are paying taxes to government that go into the health system, so why should I pay for my employees’ medical aid?'” Van Wyk explains. “Business people seem happy for their staff to stand at the government hospitals for two days waiting to be treated. Most business managers have no idea what it’s like to be treated at a government hospital.”
In 2003, Nampower started paying all employees’ medical aid premiums in full, as part of the company’s response to the AIDS epidemic. Nabcoa says its studies show that Nampower and other companies making medical aid contributions on behalf of its semi-skilled and unskilled workers recoup their costs through increased productivity. “It’s definitely cost effective”, says Van Wyk.

Copyright © 2006 Insight Namibia