The Consumer Council of Fiji is advocating for urgent changes to health insurance practices throughout the country in light of growing concerns regarding the reimbursement-based model. This call for reform follows numerous complaints from consumers about the policies of major insurance companies, which require clients to pay for medical treatments upfront and then seek reimbursement later.
A study conducted by the Council emphasizes the necessity for a more streamlined direct billing system that aligns with global standards, allowing insurers to settle bills directly with healthcare providers within an extensive network. The Council’s recent analysis has shown that the reimbursement model utilized by leading health insurance firms in Fiji places considerable financial strain on consumers, especially during emergencies or when ongoing treatments are necessary.
Council CEO Seema Shandil stated that, despite having comprehensive insurance policies, consumers are compelled to pay medical expenses out of their own pockets before receiving any support from their insurers. She questioned the rationale behind requiring Fijians to maintain $2,000 to $5,000 on hand for upfront payments to healthcare providers, considering the high premiums they already pay.
Shandil pointed out that many middle-income families who opt for health insurance are already living paycheck to paycheck. She argued that insurance should alleviate financial pressure rather than worsen it, noting that it is unacceptable for insured individuals, many of whom pay significant premiums, to still face the burden of large medical bills before enduring long waits for reimbursement. She remarked that this practice undermines the very purpose of having insurance.
One major issue is with significant private hospitals that reportedly ask health insurance policyholders to pay upfront for services, even when these hospitals are part of the approved provider network. Shandil indicated that the lack of transparency and service damages consumer trust, particularly as these insurance companies often highlight their financial success without addressing fundamental consumer needs.
The Consumer Council’s research compares Fiji’s health insurance providers with best practices globally. The Council noted that in countries like Australia and New Zealand, direct billing systems are common, enabling insurers to pay healthcare providers directly and removing the necessity for upfront consumer payments. This approach eases financial burdens and allows for timely access to healthcare.
The Consumer Council is urging insurance providers to shift from the current reimbursement model to a complete direct billing system, akin to those in Australia and New Zealand. Shandil emphasized the need for insurers to enhance communication and transparency, offering clear information about policy details, including co-payment obligations and exclusions, while also informing consumers of any policy modifications in advance.
The Consumer Council plans to engage with relevant insurance providers and government agencies to prioritize these reforms and develop a more consumer-friendly healthcare system.