The Consumer Council of Fiji is advocating for urgent changes to health insurance practices nationwide due to increasing concerns regarding the reimbursement-based model. This call to action follows numerous complaints from consumers about the unfair policies imposed by major insurance companies, which require patients to pay out-of-pocket for medical services before seeking reimbursement from their insurers.
The Council’s investigation emphasizes the need for a direct billing system that aligns with global standards, where insurers would directly pay healthcare providers within an extensive network. Recent analysis from the Council has shown that the current reimbursement system causes considerable financial strain on consumers, especially during emergencies or when long-term treatment is necessary.
CEO Seema Shandil stated that despite having comprehensive health insurance, many consumers are compelled to handle medical expenses independently before receiving any financial support from their insurers. She pointed out that needing between $2,000 and $5,000 upfront to settle healthcare bills raises issues about the value of paying high premiums.
Shandil noted that for numerous middle-income families, managing finances while relying on health insurance is already difficult. She stressed that insurance should alleviate, not intensify, financial burdens, and it is unacceptable that insured individuals, who pay substantial premiums, must endure high medical costs on their own while waiting for reimbursement.
One significant issue revolves around major private hospitals, where patients with health insurance are reportedly required to pay upfront for services, even though these facilities are included in the networks of approved providers. Shandil pointed out that this lack of clarity and service erodes consumer trust, particularly since these insurance companies often highlight their financial achievements while failing to meet fundamental consumer needs.
The Council’s research has drawn comparisons between the health insurance models in Fiji and best practices worldwide. In countries such as Australia and New Zealand, direct billing is the standard practice, allowing insurers to pay healthcare providers directly, thus eliminating the need for upfront payments from consumers and reducing financial challenges related to accessing care.
The Consumer Council is urging insurance providers to shift from the existing reimbursement-based model to a complete direct billing system akin to those in Australia and New Zealand. Shandil also emphasized the necessity for insurers to enhance communication and transparency about policy details, including co-payment obligations and exclusions, as well as to inform consumers of any policy changes in a timely manner.
The Consumer Council plans to engage in discussions with relevant insurance providers and government agencies to prioritize these reforms and foster a more consumer-friendly healthcare environment.