Pacific Family Health Journal with Dr Rodney Itaki
Private Health Insurance in Papua New Guinea Can Improve Access To Private Primary Healthcare.
I have noted in recent times there is a general push for private medical insurance. And I would like share my experience in PNG regarding private medical insurance.
The first thing to remember is an insurance company is a business. The primary objective of businesses is to make a profit. If a business does not make profit for its owners and share holders, what’s the point of operating it?
Medical insurance is sold on the promise that the insurance company will help pay for your medical expenses in the event that you get sick or injured. However, there are rules about how much to pay, what to pay for and who to pay for. So it is very important that before you start paying insurance premiums, make sure you read the rules (ie terms and conditions) very carefully.
Some medical insurance plans will allow you to pay medical expenses out of your own pocket and you get reimbursed a certain percentage back. For example the plan may say the client pays 100% of the costs and the insurance companies will give back 80%, provided all the documents are in order and the service that the client accessed is in the plan.
I think this form of insurance is stressful to the client and people should not take up this type of health insurance plan. Why do I say that? If I was the client, why should I pay insurance every pay day (or monthly or yearly) and then I have to save up again to ensure I have finance to pay for private medical care. And the stress of obtaining all the documents and submitting to the insurance company and wait for payment. It may take months before any form of payment if made by the medical insurance company. Sometimes the payment may be denied outright.
There are other medical insurance plans that will allow you to pay only a small fraction (say 20%) of the cost to access private healthcare while the healthcare provider then back-bills the insurance provider to pay for the balance of the cost.
In my opinion, this arrangement benefits the client and improves access to private healthcare, especially primary healthcare. This is because you don’t have to worry about saving up for medical expenses because you know you will only pay a small fraction and the insurance company will take care of the rest. It is left to the medical care provider and the insurance company to negotiate what to pay for and what not to pay for.
As the middle class in PNG continue to expand, many young families will be considering medical insurance for their families to access primary healthcare provided by private medical providers. My advice is to study the rules carefully and choose the plan that best suits you financially.
Dr Rodney Itaki, MBBS, BMedSci
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