I wish to refer to the business feature article from the Consumer Council of Fiji published in The Fiji Times (15/08/20) titled Choosing suitable “health care cover.
It was a well written advise to the community at large on various aspects of health insurance cover that is available locally.
I wish to add more cautionary notes for the community to be aware of when choosing and debating private medical or health insurance schemes but let me first outline a brief history.
Early history of private medical insurance scheme in Fiji.
Blue Shield/Blue Cross were the first private medical insurance scheme that started in Fiji when Sheraton Fiji Resort opened for business in 1988.
Late Dr Arthur Dass and myself were the first private/general medical practitioners who signed up to be the providers of health care to the entire staff of Sheraton Fiji Resort.
This was an entirely new concept in Fiji where Blue Shield/Blue Cross paid us directly for services at a fixed capitation fee.
The health care cover extended to all the families of Sheraton Fiji staff at the same premium rate.
The management paid 50 per cent of the premium and the other 50 per cent paid by staff members, deducted weekly from their salaries.
By and large this has continued until today although there has been a number of adjustments and improvements to the scheme.
We encountered numerous issues and problems with this scheme though.
Many staff members were unhappy with just two doctors in the scheme which soon allowed all other general practitioners (GPs) in Nadi to be part of the scheme as long as they agreed on the terms and conditions of the insurance policy.
Since some staff also lived in Lautoka and Ba, GPs were requested to sign up there as well that allowed wider coverage of health care.
Terms of conditions
Accepting a fixed capitation fee per family, per year (paid in monthly installments);
The fee paid to us was based on 3.25 visits per annum. This figure was based on Australia and NZ experience;
Number of visits or consultations unlimited;
There was no up front payment;
ID cards were issued to all staff with nominated doctors;
Chronic medical conditions such as hypertension and diabetes were excluded;
All drugs to be dispensed by only one pharmacy in town;
Generic drugs to be prescribed rather than the branded products;
All hospital admissions were covered extended to private wards and specialists; and
Optician/optometrists referral also covered as long as referred by nominated GPs.
After hours consultations and treatment were not covered. Staff members were advised to attend local hospitals for all after hours emergencies.
Office procedures such as injections, stitching, diagnostic procedures such as ECGs, blood tests, syringing of ears etc were not covered.
Problems or teething issues
Unlimited patient consultations amounted to more than seven consultations or visits rather than 3.25 as projected by the insurance company and the GPs paid only for 3.25 visits per annum (as applicable in NZ and Australia).
There were unnecessary visits to GP clinics for minor illnesses or for routine check ups.
Prescriptions for just panadol and cough mixtures often requested by patients (adding to unnecessary or unwarranted visits) were covered.
Referral to opticians for eye check ups and glasses often requested (even though unwarranted). The referral note would qualify the Opticians to claim their charges including eye glasses prescribed.
Requests to prescribe medications for their family members not covered in the scheme.
This was a new “ball game” that many staff would flash their cards in our clinics for services at anytime of the day or night and wanting to be served immediately without making appointments.
The insurance company sold the product (to other companies as well later on) without consulting the GP’s who were central figures to the scheme.
Conflict resolutions
By this time we (GP’s ) had organised ourselves into an association known as Western Private Medical Practitioners Association (WPMPA) and I was the foundation secretary.
I held several meetings with the management of Sheraton as well as the insurance company for better terms and conditions.
We managed to control the abuse of the first ever private medical insurance scheme in Fiji which prevented a collapse of the system.
Sheraton resort had promised all of their staff of the better terms and conditions including health care coverage that was not provided by any other hotel in Fiji.
An upfront fee of $1 was introduced for consultations as the first step towards controlling the abuse of the system and likewise pharmacists were also instructed to collect $1 before dispensing the drugs.
This largely resulted in quickly fixing some of the teething issues and all the parties were quite content with the outcome.
Blue Shield/Blue Cross soon folded up after three-four years of their operations in Fiji and was taken over by Colonial National Bank.
This didn’t last long and by this time a new insurance company known as Insurance Welfare Society, established in 1989 took over the operations. It later became Fiji Care Welfare Society in 1993 and finally from 1995 until today, Fiji Care Insurance Ltd .
Sheraton staff members insurance scheme remained intact during this turbulent period which still remains today as one of the best examples of private medical insurance scheme.
Other insurance companies emerged namely BSP Health, Capital Insurance, and may other inhouse medical schemes such as those set up by FTU, FPSA, Police, Army and others.
Central players
In any of the schemes or companies offering private medical insurance, the central players or figures are the GPs as mentioned earlier. Contact or consult your GP to dispel any doubts or get the correct answers on any of the schemes on services provided etc etc…
National health
insurance scheme
Sadly this has eluded us for several decades despite many attempts in the past.
I had made several proposals and submissions in the past as President of Fiji College of General Practitioners for a National Health Insurance Scheme.
It cannot be delayed any further despite the pandemic crisis facing us today.
A family doctor
for every family
A national health insurance scheme combined with the private medical insurance schemes will allow every family to have a family doctor.
The only meaningful primary health care is provided by GPs or family doctors (commonly referred to as private doctors in Fiji).
This is a universal truth and only then we’ll see reversal of non-communicable diseases (NCD’s) in this country.
NCDs and Fiji’s lifespan
We are all well aware of the staggering figures for NCDs which accounts for about 80 per cent of all morbidity and mortality in Fiji.
Our average life span has remained stagnant at 69 years for the past 20 years, holding 118 position in world rankings.
This lifespan is unlikely to change in the near future despite strides and advancement in tertiary health care and technology. Japan is number one at 84 yrs and our close neighbours Australia is 6th at 83 years and New Zealand 15th position at 82 years.
Primary health care in all of these countries lies squarely in the hands of the GPs and everyone has an insurance policy for health.
A Universal Health Insurance Scheme is imperative for Fiji.
* Dr Ram Raju is the president of Nadi Chamber of Commerce and Industry and also a general medical practitioner. The views expressed are the author’s and does not necessarily reflect the views of this newspaper.
