Towards a new era in health

| Thursday January 14, 2010 00:00

 

At its opening, during what the hospital has dubbed phase one, the hospital will have 200 and a further 130 beds during the second and third phases. But the opening of the hospital also brings with it many questions from the public and anxiety from competitors.

Already there are allegations that the owners of the hospital  - the two government medical insurances in PULA and Botswana Public Officers Medical aid scheme (BPOMAS) are not able to honor payments for members who visited private practitioners. GREG KELEBONYE asks KABELO EBINENG, the Managing Director of Associated Fund Administrators (AFA), the organisation that manages BPOMAS and PULA to shed light on the developments following the opening of the hospital.

Mmegi:  There are fears that with the opening of the BOKAMOSO hospital, members of schemes that AFA administers will be forced to first seek medical assistance from the hospital and not only go elsewhere - be it locally or in the region. Some of the ways that people fear the schemes may use to 'persuade' members include setting a limit, which would be within what BOKAMOSO can provide and having members themselves pay anything beyond that limit. Do you think these fears are unfounded?

Ebineng:  In line with the Botswana Constitution, and the constitutions of both BPOMAS, and PULA - beneficiaries of BPOMAS and PULA have, from inception of the two medical aid schemes had the right to choose their service providers, when seeking bio-medical services. That right to choose remains, and will not be altered by the fact that the BOKAMOSO is now in place. In making the choices, it has been understood, and we believe that it will remain understood that: choices come with obligations. To the extent that, a patient chooses services that cost more than the limits payable by each or either of BPOMAS and/or PULA, it has and will remain the practice that such a patient will make good the difference in rates, or tariffs-if any.

That situation has applied, in respect of other service providers(hospitals , doctors etc), before the advent of Bokamoso, and will, in fact, continue-when one considers that different entities charge differently, but patients have the freedom of choice to consult whoever they wish. As for the matter of setting benefit limits-one has to understand that: not only are these limits a function of balancing aspects of the consuming public's levels of affordability with the same consumers' demand for needed health services, but Bokamoso has to operate as an economically viable entity. Accordingly, the long-term aim of each of BPOMAS and PULA must be to assure the required access to care is achieved by providing reasonable limits, which members can afford - in terms of monthly subscriptions, yet such subscription levels, combined with demand from other consumers, are sufficiently high to pay for Bokamoso's services, at a long-term cost, which will be lower than would otherwise have been the case-had nothing been done.

Mmegi:  Between themselves, the medical insurances that AFA administers command a much bigger membership than any medical insurance in the country - considering the government is the country's major employer. How would you ensure fair competition between other health service providers such as say the Gaborone Private Hospital and other Health Private Establishments? For instance there have been allegations that the Gaborone Private Hospital may fold up in the face of expected competition from Bokamoso.

Ebineng: I cannot answer on the matter of fair competition-because that is a regulatory issue: neither can I comment on what Bokamoso's competitors-whether local or international can and should do.

All I can say is that: it is common cause that: Botswana is a free market environment, where any entity can proceed as it wishes-as long as it operates within the law, and does not offend societal norms. So, those who compete with each or any of BPOMAS, PULA and Bokamoso should be free to do the best they can, in their interests-the same way that BPOMAS, PULA and Bokamoso ought to be able to do. However  It would be the wish of each of BPOMAS, PULA and Bokamoso that people would choose, and prefer to use Bokamoso - on the basis of its quality and outcomes; as well as overall cost-effectiveness; regarding service-delivery. It must be noted that one of the key aims of Bokamoso is to bring much needed services, and technology closer to Batswana, and residents of Botswana, at a relatively lower cost than would otherwise have been, at least based on history, and one's total cost -including transport etc of accessing services, say in South Africa.

Mmegi: To what extent do you anticipate health private practices to be affected by the opening of BOKAMOSO Hospital?

EBINENG:  I cannot speculate on what will happen to private health practices that are now going to compete with Bokamoso. That question can only be answered by time, and the consumer's choices?

MMEGI: There are allegations that the medical insurances that you administer, namely BPOMAS and PULA have failed to honor payments to a number of local and international private practitioners. Is this true and are the two insurances currently experiencing any cash-flow problems due to the insurances having dispensed a lot of funds in the construction of BOKAMOSO Hospital?

EBINENG: I can assure you that BPOMAS and PULA have capacity to settle their claims-notwithstanding that they have invested some of their money in the Bokamoso development. Those two medical aid schemes continue to honour their claims in the same manner they have done over the years-be it in respect of local or international health service providers. I can also confirm that BPOMAS and PULA do not have any cashflow problems-as alleged.

I know, however, that certain people, including those in the service-provision side have speculated to that effect. Some have put the question directly to us-even at the Bokamoso feasibility study stage that-BPOMAS and PULA would not be able to raise funds for the development, and certainly would not be able to get the requisite staff; never mind affording them. Well, we are where we are today, and we can only commit to doing the best we can, in an as open a manner as commercial, and other such considerations dictate. Rraetsho, ao mahoko a go tweng BPOMAS le PULA di na le mathata a madi ka di agile Bokamoso ga re a itse-a ka itsiwe ke ba ba a buang.

Mmegi: What specialized health medical services does BOKAMOSO offer?

Ebineng: In addition to a major trauma program, the hospital will provide orthopaedics, cardiac care, neuroscience and oncology specialities. Labor, Delivery, Recovery, and Post-Partum (LDRP) obstetrics unit is part of a comprehensive Women's and Children's Health Care Program.  Haemodialysis will be offered in Botswana for the first time.  The hospital's radiology and pathology laboratories are equipped with state of the art technology some of which will also be available in Botswana for the first time.  The Hospital also has an advanced Information Technology Department and system that will support Electronic Medical Records with satellite connectivity to the United States and other countries.

Mmegi: The hospital should have opened last year. What delayed its opening?

Ebineng: The delayed opening of the hospital is a function of a delay in the handover of the project, from the contractor-mainly.