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.    

Mission 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.

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                                                                              Membership Trends - PSEMAS Total               Total     Total                Ave /Dep per       Members    Dependants      Pensioners      Members            Lives 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 1.22 230248 Jan 2014 –June  2014 104055 128028 1.23 232083 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