Having spent more than 20 years of his life with Met Health and saw it grow into one of the country’s largest medical aid administrators, Theo Opperman (TO) is finally calling it a day. He sits with Prime Focus Managing Editor Tiri Masawi and Journalist Rosalia David (RD) to discuss the milestones achieved by Met Health, how it has conquered the industry and also to shed light on the way forward for the company. The following is a full transcript of the engagement with Opperman.
RD: How would you summarise your tenure as the head of Methealth?
TO: As an introduction, I would like to give a short overview of the medical aid fund industry and the role that the Administrator plays. A medical aid fund is essentially a trust that belongs to its contributing members. These members appoint from their ranks a board of Trustees to manage the finances and operations of the Fund. The Fund in turn appoints an administrator to register members, collect premiums and pay claims.
My 20 years at Methealth Namibia Administrators have been a progressive and exciting time. I feel privileged to have been in contact with, I met and worked with so many extraordinary people.
The company was established in 1996 as Namibia Healthcare Advisors (NHCA) and delivered only Managed Healthcare and electronic data interchange facilities for health professionals. In 1997 Namibia Medical Care (NMC) approached the company to assist them with the verification of medication and soon thereafter the company took over the full administration of the Fund. PSEMAS (Public Service Employees Medical Aid Scheme) soon followed and NHCA also performed medication verification for them.
Sanlam Namibia bought shares in the company in 1997 and Metropolitan in 2001. This is also the year that the company took over the administration of Bankmed Namibia. In 2004 the full administration of PSEMAS was awarded to Methealth Namibia Administrators. We have since been the administrators to NMC, Bankmed Namibia and PSEMAS. Methealth administers 75% of all medical aid members in Namibia. Looking back over the achievements of the company, I feel unbelievably proud and extremely grateful for the opportunities and development that we have experienced.
RD: What are some of the challenges that you encountered during your tenure as the Managing Director Methealth?
TO: The medical aid fund industry is a very complex environment and I found meeting the expectations of all the different stakeholders (members, trustees, health professionals, industry role players, shareholders, employees, registrar) simultaneously quite challenging.
RD: Could you give us an overview of how Methealth has grown and subsequently changed its operations in the past three years?
TO: Membership on all the Funds continue to grow on an annual basis. From an administrative point of view, Methealth has ensured that it has enough staff and sufficient branches to deal with an increased number of members. Excellent service to all stakeholders remains our number one priority.
RD: Research shows that only about 15-16% of the Namibian population have regular access to private health services, how does Methealth make sure that average Namibians are able to afford medical aid?
TO: As Methealth Namibia Administrators do not sell medical aid benefits, but rather administer it, we have limited input in the affordability of medical aid. It is however a concern to us as well and we believe that the biggest obstacle is the access to health professionals. There are too few primary healthcare facilities, doctors and hospitals to adequately provide service to all.
RD: The rest of Namibia’s population (84-85%) is dependent on a public health system, which , by government’s own admission, is beset with various shortcomings which often compromise the quality of health care, leading in some instances to preventable loss of life. What strategies has the company put in place to assist in decreasing loss of life through poor medical assistance?
TO: Methealth together with Namibia Medical Care established the Student Financial Assistance Fund and have been supporting Namibian medical and pharmaceutical students since 2008 in an effort to get more medical staff working and operating in Namibia.
RD: What are some of the goals, with regards to making sure that Methealth appeals to the generality of the Namibian market?
TO: Since Methealth does not set the product or options. This is a function of the medical aid funds.
RD: Methealth’s responsibilities are to provide administration and manage health care services to Medical Aid Funds in Namibia, how successful has this been?
TO: Methealth has been extremely successful in ensuring that members and service providers receive efficient service and claims payments. Our reputation and the fact that we have retained our clients and that the Funds continue to grow in membership speaks for itself.
RD: Could you outline some of the milestones and accomplishments that the organisation has garnered since its inception?
Being an effective and efficient administrator to 347 000 members (lives) and thus 75% of all medical aid fund members in Namibia is definitely our key accomplishment.
RD: How does Methealth contribute to the Namibian Health sector?
TO: Through the student financial assistance trust, we ensure that more doctors and pharmacists are trained and available in Namibia. By facilitating on-time payments to health professionals, we ensure that the private medical aid sector stays in a healthy financial position.
RD: How has Methealth sensitised the public to be aware of the benefits of having access to medical aid?
TO: by supporting the medical aid funds that we administer to ensure that members and the public at large are well informed through advertisement campaigns and newsletters.
RD: According to your assessment, do Namibians understand or accept the importance of having medical cover?
TO: I think that most people understand that medical cover is important, but unfortunately it is expensive and therefore not accessible to all.
RD: What is the average Namibian’s challenge that prevents them for acquiring medical cover?
TO: Private medical cover is expensive. Also the fact that medical aid is a grudge purchase. Many people only think of medical coverage once they need it, which is of course too late.
RD: What projects has the company set out to make sure that it fulfils its social responsibilities?
TO: The company supports many small projects every year, but our main social responsibility is our support for the NMC/Methealth Financial Assistance Trust where we support medical and pharmaceutical students financially to enable them to complete their studies.
RD: Do you think that in the future there is need for establishment of new medical insurance companies to increase the availability of coverage?
Not at all. I think that the current medical aid funds and its administrators have the capacity to cover the entire Namibia. The challenge lies in the shortage of medical facilities and health professionals. Our doctors and facilities are filled to brim – we need more healthcare facilities and more health professionals in Namibia. Shifting the entry point from general practitioners to primary healthcare care clinics will also be needed. Most people visit GPs for allergies, colds and flu advise. These are all ailments that can be treated more cost effectively through primary healthcare clinics or pharmacies.
RD: Who are Met health’s clients?
Namibia Medical Care and its members
Bankmed Namibia and its members
PSEMAS and its members
RD: How decentralized is Methealth in Namibia?
TO: The management team all have responsibilities and policies in which they operate. They therefore have scope to complete their tasks and reach the departmental objectives. I would say that Methealth is moderately decentralized.
RD: Most Namibians live under difficult financial conditions are not able to afford medical cover do you think service providers in this regard have products that appeal to the low and medium income earning bracket of the economy?
TO: All open medical aid funds in the industry have implemented some form of low to medium income options. Some make use of the traditional system where members can see any health professional, but have limited access to benefits whilst others make use of a network of doctors at a lower, predetermined price to keep costs at a minimum.
The challenge however, remains that premiums are still too expensive and instead of partaking in the low-cost options, members only want to be part of the medical aid fund when they are ill, which means that no cross subsidization and pooling of funds takes place and the more people partake in the low cost option, the better priced it would be, the more benefit there would be to all.
RD: How do you see the company’s financial position improving in the next five years?
TO: The company aims at remaining the leader in the industry by providing excellent service to our clients. As long as Methealth looks forward and continually meets its goals. I believe that it’s financial position can only improve.