*Members demand reform as scheme posts P42.9 million loss
In February this year, Botswana Public Officers Medical Aid Scheme (BPOMAS) was dealt a heavy blow when many beneficiaries were turned away by private healthcare providers due to unpaid claims.
At the heart of the crisis was a backlog of payments that stretched over a month, leaving members unable to access services despite paying their monthly premiums in full.
The situation was further compounded by the scheme’s deteriorating financial position as BPOMAS recorded a net loss of P42.9 million for the 2024/25 financial year, a sharp reversal from the P23.4 million surplus reported the previous year.
This was revealed at the BPOMAS annual general meeting (AGM) held in Gaborone and Francistown last Friday. According to BPOMAS Chairperson, Morebodi Jamba, the group position reflected a loss before tax of P47.7 million largely driven by increased insurance service costs and reduced investment returns.
“Our challenges with failure to pay our dues to service providers emanated from the fact that government is sometimes late with paying its contribution to us. However, we remain financially disciplined, governance focused and member centred despite a challenging operating environment marked by rising healthcare costs,” he said.
While the financial year presented significant cost pressures, Jamba said it also reinforced key priorities for the scheme, strengthening sustainability through proactive cost management, improving member engagement and service accessibility, and enhancing data driven decision making.
Investment income, Jamba added, declined from P8.3 million to P5.3 million mainly due to reduced investable reserves as a result of high claims expenditure.
Despite the losses, the scheme recorded insurance revenue of P1.4 billion, a 19% increase from the prior year figure of P1.2 billion, driven by membership growth. However, healthcare costs which is the insurance service expense rose by 20% closing at P1.378 billion.
This pushed the claims ratio up from 98% to 99%, meaning nearly all contributions received go towards paying claims, leaving only 1% for operational expenses.
“This elevated claim ratio reflects increased utilisation of benefits and rising healthcare costs across the market, the current cost trajectory places pressure on long term sustainability,” said Jamba, noting that the scheme’s target claims ratio is between 80 and 85%.
While total lives covered declined marginally from 202, 379 to 201, 362, the scheme enrolled 3,669 new members during the period under review.
The earlier situation where beneficiaries were turned away with their medical aid cards rejected, was said to be causing financial strain to medical service providers, making it difficult for them to cover operational costs and forcing patients to pay cash upfront for services that should be covered by their medical aid. This was all tied to a combination of factors, including government delays in paying its portion of contributions.
During the AGM members called for various reforms to keep the scheme afloat and sustainable going into the future.
Suggestions included introduction of preventative measures and member incentives such as gym discounts, healthy food discounts, free prevention test like Prostate Specific Antigen for men over 40 years, pap smear test once a year in order to reduce claims ratio.
Though regulations regarding investment by medical aid schemes are strict, some beneficiaries have also called for BPOMAS to make more investments, such as buying property where they can derive high-value returns.
