The Consumer Council of Fiji is advocating for urgent reforms in health insurance practices nationwide due to rising concerns over the reimbursement-based model. This initiative comes after numerous complaints from consumers regarding the practices of major insurance providers, which compel individuals to pay for medical treatments upfront before seeking reimbursement.
The Council’s research points to the necessity for a more efficient direct billing system, akin to international standards, in which insurers pay healthcare providers directly within an extensive network. Findings from a recent analysis by the Council indicate that the reimbursement model employed by major health insurance companies in Fiji places considerable financial strain on consumers, especially during emergencies or for ongoing medical care.
Seema Shandil, the Council’s CEO, highlighted that despite holding comprehensive health insurance policies, consumers are often required to pay medical costs out-of-pocket before any support is provided by their insurers. She questioned the value of paying high premiums if Fijians must have between $2,000 to $5,000 available to cover healthcare expenses upfront.
Shandil noted that for many middle-income families, who already struggle to make ends meet, this situation is particularly burdensome. She emphasized that insurance should alleviate financial pressures, rather than increase them, stating it is unacceptable for insured individuals, who often pay substantial premiums, to face significant medical bills out-of-pocket while waiting weeks or months for reimbursement.
A significant issue raised involves major private hospitals, which reportedly require health insurance policyholders to pay upfront for services, even though these hospitals are part of the approved provider network. Shandil remarked that the lack of transparency and service erodes consumer trust, especially when insurance companies often flaunt their financial successes while failing to meet basic consumer needs.
The Council’s research has compared Fiji’s health insurance sector with best global practices, showcasing that direct billing is standard in countries such as Australia and New Zealand. This practice allows insurers to settle bills directly with providers, removing the need for upfront payments and reducing financial burdens, ensuring timely access to healthcare.
The Consumer Council is urging insurance providers to shift from the current reimbursement model to a comprehensive direct billing system, similar to those in Australia and New Zealand. Shandil emphasized the need for insurers to enhance communication and transparency by providing clear policy information, including details about co-payments and exclusions, and notifying consumers of any policy changes in advance.
The Consumer Council plans to engage in discussions with relevant insurance providers and government agencies to prioritize these reforms and build a more consumer-oriented healthcare system.