The Consumer Council of Fiji is advocating for urgent reforms in the country’s health insurance practices, primarily due to rising concerns about the reimbursement-based model. This initiative follows consumer complaints regarding the unfair policies of major insurance companies, which require patients to pay for medical services upfront and then seek reimbursement later.
Recent findings from the Council underscore the need for a more effective direct billing system that aligns with international standards, allowing insurers to settle bills directly with healthcare providers within a broader network.
The analysis indicates that the reimbursement model currently employed by leading insurance firms in Fiji places undue financial pressure on consumers, especially in emergency situations or for ongoing medical treatments. Seema Shandil, the Council’s CEO, emphasized that even those with comprehensive health insurance often find themselves having to pay out of pocket before receiving support from their insurers.
Shandil pointed out that if Fijians must have between $2,000 and $5,000 readily available to pay healthcare providers at the time of service, it raises questions about the value of paying high insurance premiums. For many middle-income families, who typically live paycheck to paycheck, this adds to their financial challenges.
Insurance, according to Shandil, should alleviate financial burdens, but the current practices force insured individuals—many of whom already pay significant premiums—to front large medical expenses and wait extensive periods for reimbursement. She argued that this undermines the fundamental purpose of having insurance coverage.
A significant issue involves major private hospitals, which reportedly require health insurance policyholders to pay for services upfront, despite being part of the approved provider network. Shandil noted that this lack of transparency damages consumer trust, particularly as these insurers frequently tout their financial success while failing to meet basic consumer needs.
The Consumer Council’s research compares Fiji’s health insurance providers with global best practices, noting that countries such as Australia and New Zealand generally use direct billing systems, allowing insurers to pay healthcare providers directly. This system relieves consumers of the burden of upfront payments and facilitates timely access to healthcare.
The Council is pushing for insurance providers to shift from the reimbursement model to a complete direct billing system, similar to those in Australia and New Zealand. Shandil also called for improvements in communication and transparency, urging insurers to provide clear information regarding policy details, including co-payment requirements, exclusions, and timely notification of any policy changes.
The Consumer Council plans to engage with relevant insurance companies and government bodies to emphasize the importance of these reforms and to foster a more consumer-friendly healthcare environment.