The Consumer Council of Fiji is advocating for urgent changes to health insurance practices in the country due to rising concerns regarding the reimbursement-based model. This initiative follows numerous consumer complaints about unfair policies from leading insurance companies that mandate customers to pay for medical treatments upfront and later seek reimbursement.
A study conducted by the Council emphasizes the necessity for a more comprehensive direct billing system that aligns with international standards, allowing insurers to settle bills directly with healthcare providers within an extensive network. The analysis revealed that the current reimbursement model creates significant financial stress for consumers, particularly in emergencies or during ongoing treatments.
Council CEO Seema Shandil pointed out that despite holding comprehensive health insurance policies, many consumers find themselves responsible for medical expenses before receiving any assistance from their insurers. She questioned the rationale behind requiring Fijians to have $2,000 to $5,000 available for upfront payments, suggesting that such a need undermines the purpose of paying high insurance premiums.
Shandil highlighted the struggle faced by many middle-income families who already experience financial strain living paycheck to paycheck. She stressed that insurance should alleviate, not increase, financial pressure and criticized the practice of requiring insured individuals to cover substantial medical bills upfront, only to face long delays for reimbursement.
A significant issue arises with major private hospitals, where health insurance policyholders are often asked to pay in advance for services, even though these facilities are included in the network of approved providers. This lack of transparency and service is eroding consumer trust, particularly as insurance companies often boast about their profitability while disregarding essential consumer needs.
The Consumer Council’s research contrasts Fiji’s health insurance practices with global best practices, highlighting that in countries like Australia and New Zealand, direct billing systems are standard, allowing insurers to pay healthcare providers directly. This model eliminates the need for upfront payments, reducing financial burdens and facilitating immediate access to healthcare.
The Council is urging insurance providers to shift from the current reimbursement-based framework to a full direct billing system, similar to those in Australia and New Zealand. Shandil further called for improved communication and transparency from insurers, urging them to clarify policy details such as co-payment requirements, exclusions, and to notify consumers of any changes to policies in advance.
The Consumer Council plans to engage with relevant insurance providers and government agencies to prioritize these reforms and foster a more consumer-friendly healthcare system.