Wednesday, September 23, 2020

Botswana’s multi-million Pula medical bills heist exposed

Batswana on medical aid are being ripped off to the tune of millions of Pula in out of pocket (OOP) medical expenses – the Board of Healthcare Funders (BHF) has revealed.

The report by BHF has exposed a sick system under which Batswana who are on medical aid pay more for medical services, in excess of the going rate recommended by the World Health Organization (WHO). It has further emerged that Botswana’s senior citizens who are on medical aid are the hardest hit.

BHF Managing Director Dr Katlego Mothudi stopped short of warning that the high out of pocket expenses paid by Botswana medical aid clients could impoverish local households.

Dr Mothudi cautioned that “key measure included in this report is OOP expenditure by medical aid beneficiaries. Health care costs can be catastrophic and lead to financial ruin of households.”

The BHF report however does not disclose how overcharges make their way into bills in the first place. It is not clear if this massive heist of medical bills is a result of price fraud, errors or just overcharges.

OOP expenditure is the money contributed by medical aid clients for health services when they access care.

According to the 2019 BHF, Batswana’s OOP expenditure was more than P403 million, representing at least 20% of total healthcare expenditure. In 2018, OOP expenditure was P355 million, representing 19% of total healthcare expenditure.

“The World Health Organization recommends that OOP expenditure by individuals should not exceed 15% of total healthcare expenditure.”

“OOP expenditure among older ages was as high as P7 000 per beneficiary per annum in 2019. This amount translates to about 100% of the average annual contribution for medical aid fund membership (adult contributions). Older beneficiaries need more protection from OOP expenditure,” the report warned.

It emerged in the report that most OOP expenditure in 2019, about P167 million was at Healthcare Service Providers (HSPs).

This was followed by medicines and devices outside hospital, amounting to P116 million. OOP was lower at hospitals – P111 million in 2019, translating to 20% of all healthcare expenditure at

Hospitals,” the report states.

The report also shows OOP expenditure by age per beneficiary and per annum basis in 2018 and 2019. The expenditure increases with increasing age. For child dependents the levels of OOP are very low in nominal terms, however as a proportion of total healthcare expenditure it is consistent with other ages.

The report also compared HSPs in 2019 to hospitals and OOP expenditure for medicines and

devices. “The bulk of this went to pathologists, medical specialists and general practitioners. Of

the P167 million spent at HSPs, 30% was spent at both medical and surgical specialists,” states

the report.

Meanwhile the report has also raised red flags on the success of Botswana’s much celebrated

Prevention of Mother To Child Transmission (PMTC) of HIV.

“There are some children under five years of age with HIV, raising concerns about the success of mother-to-child transmission preventative interventions,” the report says.

The report further expressed concern about the number of teenagers and young adults with HIV/AIDS.

“Another concerning observation is the number of teenagers and young adults with HIV”, states the report.

It says HIV remains the most prevalent chronic condition among medical fund beneficiaries. In 2019, the prevalence of HIV was 39.6 per 1 000 beneficiaries, compared to 39.9 per 1 000 beneficiaries in 2018. The report says Cardiovascular (CVS) diseases, which include hypertension, coronary artery disease, cardio-myopathy, cardiac failure CVS-related diseases were the second most prevalent, with a prevalence of 27.9 per 1 000 beneficiaries in 2019.

This is higher than the prevalence of 25.7 per 1 000 beneficiaries in 2018.

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The Telegraph September 23

Digital edition of The Telegraph, September 23, 2020.