The Consumer Council of Fiji is advocating for immediate reforms in health insurance practices due to rising concerns regarding the reimbursement-based model. This call for action comes after receiving numerous complaints from consumers about the unfair policies imposed by leading insurance providers, which require patients to pay for medical treatments upfront before seeking reimbursement.
A study conducted by the Council emphasizes the necessity for a more comprehensive direct billing system, similar to international standards, where insurance companies settle bills directly with healthcare providers across an extensive network. The analysis reveals that the reimbursement model being used by major health insurers in Fiji places significant financial strain on consumers, particularly during emergencies or when ongoing treatment is needed.
Council CEO Seema Shandil pointed out that even consumers with comprehensive health insurance are often compelled to pay medical bills out of their own pockets before receiving any reimbursements from their insurers. She questioned the rationale behind paying costly premiums if individuals need to have $2,000 to $5,000 readily available to cover upfront healthcare costs.
For many middle-income families opting for health insurance, managing finances on a weekly basis is challenging. Shandil expressed that insurance should alleviate financial stress rather than intensify it, stating it is unacceptable for insured individuals—who often pay high premiums—to bear substantial medical expenses before facing delays of weeks or months for reimbursements.
Another significant issue raised involves major private hospitals, where policyholders are reportedly required to pay upfront for services, even when these hospitals are part of the insurer’s approved network. This lack of transparency is eroding consumer trust, especially when insurance companies highlight their financial successes while overlooking fundamental consumer needs.
The Council’s research compares Fiji’s health insurance practices with global benchmarks, noting that in countries like Australia and New Zealand, direct billing systems are standard. This approach allows insurance providers to pay healthcare facilities directly, eliminating the need for upfront payments and reducing financial burdens while ensuring timely access to medical care.
The Consumer Council is urging insurance providers to shift from the current reimbursement model to an all-encompassing direct billing arrangement, akin to the systems employed in Australia and New Zealand. Furthermore, Shandil emphasized the need for insurers to enhance communication and transparency by providing clear policy details, including co-payment requirements and exclusions, along with timely notifications of any policy changes.
The Consumer Council plans to engage with relevant insurance providers and government entities to prioritize these essential reforms and establish a more consumer-friendly healthcare system.