The Consumer Council of Fiji is calling for immediate reforms to the nation’s health insurance system, citing concerns over the current reimbursement-based model used by major insurers.
This comes after a growing number of complaints from policyholders, who report having to pay upfront for medical treatments and then wait for reimbursement, placing significant financial pressure on consumers.
A recent report from the council showed that this reimbursement system can cause undue hardship, particularly for those facing medical emergencies or requiring ongoing treatment. Although many Fijians have comprehensive health insurance coverage, they are still being forced to cover medical costs out of pocket before receiving any financial support from their insurers.
Seema Shandil, CEO of the Consumer Council of Fiji, said insurance should ease, not exacerbate, financial stress.
“It is unacceptable that insured individuals, many of whom are paying significant premiums, are still being asked to cover large medical bills on their own before waiting weeks or months to be reimbursed,” she said, adding that this practice undermines the purpose of health insurance.
One issue raised by the council is that private hospitals are reportedly demanding upfront payments from insured patients, even though these hospitals are part of the insurer’s network.
The council said this lack of transparency is damaging trust in the health insurance sector, particularly as insurers often report strong financial performance without addressing key consumer issues.
The report also compared Fiji’s health insurance model with international practices, such as those in Australia and New Zealand (ANZ).
In ANZ, direct billing systems are the norm, with insurers paying healthcare providers directly, which eliminates the need for patients to pay upfront.
The council is advocating for Fiji to adopt a similar system, which would reduce financial pressure on consumers and improve access to care.
The Consumer Council of Fiji is calling for health insurance reforms amid healthcare access concerns in New Zealand.
Healthcare access has become a top priority for New Zealanders, according to the 2024 Southern Cross Healthy Futures report.
The report, which surveyed over 7,000 people across the country, found that 84% of respondents are concerned about the availability of affordable, high-quality healthcare, marking a 6% increase compared to 2022.
In addition to financial concerns, the report identified other obstacles to healthcare access, including long wait times and a shortage of healthcare professionals. Some New Zealanders have delayed or avoided seeking treatment due to these barriers.
Telehealth services, such as virtual GP consultations via platforms like CareHQ, are gaining popularity as a way to address these challenges
