Politics and policy
By MUGAMBI MUTEGI, pmutegi@ke.nationmedia.com
In Summary
- The insurer is yet to determine by how much it will increase its in-patient rebate amount that currently stands at Sh1,900, and which mainly goes to settle the cost of a patient’s hospital bed.
- Contributors remain in the dark as to where and when they could access the much-touted enhanced services despite having started paying higher premiums to the new scheme last month.
- Workers and employers have been strongly opposed to the increases in monthly premiums, questioning the NHIF’s corrupt past and its capacity to administer the huge scheme.
Contributors to the National Hospital Insurance Fund
(NHIF) have to wait longer to access enhanced medical services after the
public health insurer said the higher fees it began collecting this
month will be used to build a capitation pool from which to pay hospital
bills.
News of the impending delay in accessing the benefits came
even as the insurer remained tight-lipped on whether contributors will
be allowed to use their NHIF cover to access medical services in
high-end private hospitals such as Nairobi Hospital and Karen.
The NHIF, which started deducting higher premiums last month, said it was discussing capitation rates with the hospitals.
The insurer is also yet to determine by how much it
will increase its in-patient rebate amount that currently stands at
Sh1,900, and which mainly goes to settle the cost of a patient’s
hospital bed.
Yesterday, the NHIF said it will in the coming
weeks invite contributors and their dependants to pick a preferred
hospital from a list of approximately 1,600 health service providers.
The NHIF, which has 4.5 million members, has until
now been providing in-patient cover for its contributors but the new
rates are meant to extend its coverage to outpatient services.
“The contributions we began collecting last month
will be used to pay hospitals a monthly capitation fee depending on the
number of contributors, who select a particular institution,” Simon ole
Kirgotty, the fund’s CEO, said.
Mr Kirgotty said the national programme would be
rolled out in June when the NHIF would start paying hospitals before
they treat contributors.
The uncertainty over what benefits the contributors
are entitled to has been compounded by the near absence of public
sensitisation on their rights under the new regime — a gap that could
create a backlash in the event users’ expectations are not met.
Contributors remain in the dark as to where and
when they could access the much-touted enhanced services despite having
started paying higher premiums to the new scheme last month.
On February 13, the NHIF gazetted rules that
require Kenyan workers earning between Sh50,000 and Sh59,999 to
contribute Sh1,200 to the scheme every month and the self-employed Sh500
a month up from Sh160.
Those earning Sh5,999 and below are required to pay
in Sh150 while the top earners with a monthly pay of more than
Sh100,000 must pay in Sh1,700, a 431 per cent increment.
Workers and employers have been strongly opposed to
the increases in monthly premiums, questioning the NHIF’s corrupt past
and its capacity to administer the huge scheme.
The NHIF reckons that review of monthly premiums
was necessary for the planned improvement of services. The introduction
of an out-patient cover has been the fund’s major selling point during
the transition.
The NHIF contributors are currently entitled to an in-patient
cover (whereby the public insurer pays the Sh1,900 rebate) and maternity
cover worth Sh6,000 and Sh18,000 for normal and C-section deliveries
respectively.
Civil servants and members of the disciplined forces are,
however, covered for outpatient services through a special scheme that
was launched in 2012 but was immediately hit by a mega scandal involving
selection of providers.
The new out-patient cover will offer services like
general consultation, treatment of sexually transmitted diseases, renal
dialysis, X-rays and minor surgical procedures.
“The outpatient cover will not have a limit like
insurance firms; it will offer comprehensive cover to all deserving
patients no matter how many times they fall sick,” said Margaret Nzwii,
the acting general manager for operations at the NHIF.
The list of hospitals, which members will “by the
end of the month” be invited to pick from (for both outpatient and
inpatient services), has been divided into three categories, the NHIF
said.
Category One has public facilities such as Kenyatta
National Hospital in Nairobi and Eldoret’s Moi Teaching and Referral
Hospital while faith-based health service providers such as St Mary’s
Mission Hospital in Nairobi are in Category Two.
“When a patient visits either a public or
faith-based hospital, they will simply walk in and walk out without
incurring any extra expense whatsoever,” said Ms Nzwii.
The NHIF had previously indicated that those paying
the highest premiums (Sh1,700 per month) will have their annual
benefits capped at Sh1.2 million while those paying the least will have a
Sh30,000 limit.
In the third category are high and low-end private
hospitals, which most Kenyans prefer because they are better equipped
and well-managed.
The NHIF had initially planned to restrict access
to outpatient, inpatient and maternity services to public hospitals and
low-cost private hospitals but that now appears to have been shelved.
This limitation would have meant that private
sector employees who are already accessing quality medical care from
private hospitals would continue to depend on employer-sponsored
schemes, with the higher premiums adding to labour costs without the
benefit of a healthier workforce.
The statutory fund’s argument has been that locking
out high-end private hospitals like Aga Khan, MP Shah, Mater and Karen
was purely to avoid the higher charges.
The NHIF’s cover for civil servants and the
disciplined forces, which is being used as a reference for the new plan,
does not exclude high-cost facilities.
“We are in talks with the high-end private
hospitals about their ability to provide out-patient services,” Ms
Nzwii. “We shall be presenting them with our proposed rates offering
them a chance to sign up. It is a willing buyer and willing seller
scenario, meaning only those high-end hospitals that find our rates
sustainable will sign up.”
The new scheme will cover the principal member,
their spouse and an unlimited number of children aged up to 18 and 23 if
they are still in college.
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