The Consumer Council of Fiji has called for an urgent reform of health insurance practices nationwide due to growing concerns regarding the reimbursement-based health insurance model. This appeal follows numerous complaints from consumers regarding the policies of prominent insurance providers that require patients to pay for medical treatments upfront and then seek reimbursement afterwards.
The Council’s research indicates a pressing need for a direct billing system that aligns with international standards, allowing insurers to settle bills directly with healthcare providers in a broad network. An analysis conducted by the Council revealed that the current reimbursement model places significant financial strain on consumers, particularly in emergency situations or for ongoing treatments.
Seema Shandil, the CEO of the Council, stated that even individuals with comprehensive health insurance policies are often burdened with out-of-pocket costs before receiving any support from their insurers. She questioned the rationale behind requiring Fijians to have $2,000 to $5,000 readily available for upfront payments to healthcare providers when they are already paying high premiums.
Shandil emphasized that many middle-income families, who depend on health insurance, are already struggling to make ends meet. She argued that insurance should alleviate financial strain rather than add to it, noting that it is unacceptable for insured individuals paying considerable premiums to still face the burden of large medical bills before receiving reimbursement, which may take weeks or months.
A significant point of contention involves major private hospitals, where policyholders are reportedly asked to make upfront payments for services, despite these hospitals being part of the approved provider network. Shandil highlighted that this lack of transparency is eroding consumer trust, especially as these insurance companies often promote their profitability while overlooking fundamental consumer needs.
The Council’s findings have drawn parallels between Fiji’s health insurance providers and best practices observed globally. In countries like Australia and New Zealand, direct billing systems are standard, allowing insurers to handle payments directly with healthcare providers, thereby eliminating the need for consumers to pay upfront and reducing their financial burden.
The Consumer Council is urging insurance providers to shift from the reimbursement-based model to a comprehensive direct billing system, similar to what is implemented in Australia and New Zealand. Shandil stressed that insurers must also enhance their communication and transparency, providing consumers with clear information about policy details, including co-payment obligations and exclusions, while notifying them of any policy changes well in advance.
To facilitate these reforms and foster a more consumer-friendly healthcare system, the Consumer Council plans to engage with relevant insurance providers and government agencies.