Health Talk: Nip the rot in the bud at PSMAS

PSMAS issues continue to hog the limelight with various actions being taken in a bid to restore sanity to the beleaguered medical aid society. The medical aid society has lost significant credibility in the eyes of its clients who have struggled to access basic medical care in the country. There are nauseating reports of maladministration, corruption and general maleficence which have gone for too long without a solid remedy. The consequences have been drastic with closure of many units under Premier Service Medical Investments. The burden is transferred to the patients, many of them are civil servants whose meagre salaries are pathetically eroded by the sky-rocketing inflation. Service providers have for long been grumbling about PSMAS as the medical aid society has perennially failed to honour its payment obligations. Despite the fact that the medical aid society has often failed to pay its dues, many service providers have audaciously continued to attend to PSMAS patients. Many medical practitioners have been forced off business with resultant migration to greener pastures.

The last few weeks saw many service providers being summoned by police for alleged fraud involving PSMAS claims. Medical practitioners are hauled before the courts charged with fraud arising from using incorrect tariff codes for the claims. According to investigators, it is criminal to use a wrong code for claims and someone has to face justice. One has to understand that there are many numerous tariff codes for claims and it is very easy to pick the wrong one because some of the codes are interchangeable. Some tariff codes are so confusing that one may fail to understand the meaning of the claims, making it illogical to deem it criminal. I thought the impasse would need mere engagement with all the involved service providers and not the irrational hostility of prosecution yet the same PSMAS could go for months without paying the service providers. The money PSMAS claims to have been prejudiced by service providers does not contribute to more than 3% of the total loss. Money was abused at PSMAS by executives who ventured into mining, gold buying, farming while some of them awarded themselves hefty perks which included exquisite holidays, top-of-the range cars and expensive houses. Prosecuting a service provider who is said to have prejudiced PSMAS of just US$4 000 is a mere act of scapegoating.

PSMAS should know that the service providers that are tormented today are dedicated cadres who stood with the medical aid society when many rejected its card holders. Will the service providers feel safe in future when they wake up to find police officers standing in front of their doors because of alleged fraud which is said to have been committed in 2019? How many medical practitioners will continue to accept PSMAS in view of such calamitous reaction by the medical aid society? The action by PSMAS will one day come to haunt it as I foresee extensive snubbing by service providers. Will other organisations, other than government firms, join PSMAS as a health insurer yet service providers will not accept the medical aid society card holders?

Government is the biggest contributor to PSMAS with civil servants being covered under the medical aid society.

The root causes of PSMAS demise should be nipped in the bud and appropriate action should be taken to bring order. It is sensible for government to whip PSMAS management into line for the betterment of the members who have suffered for too long.

Meritocracy should be number one priority at the organisation. Those who are not qualified to be holding offices should surely be sent home. There should be no room for nepotism and favouritism

Good corporate governance should be available at PSMAS so that issues of transparency, accountability and integrity are observed.

Prosecution of those implicated in corruption should be expeditiously done in order to bring confidence to clients

Service provider-medical aid relations should be upscaled as many service providers have lost faith in PSMAS. There is no one who wants to liquidate because the medical aid society does not pay within the stipulated 90 days. The harassment of service providers should stop if the medical aid society hopes to have good societal standing.

PSMAS should be kept under check as it has the biggest potential to become the best medical aid society, alas, the opposite is happening today.

Related Topics