NHIF biometrics roll out opens up war front

NHIF Building in Nairobi's Upperhill. PHOTO | BILLY MUTAI | NMG   

By EDWARD OMETE

More by this Author

Summary

• You not only have to be physically present but also must have your smart card to get care.
• While the smart card seems to be working for the private sector, adoption in public side has been slow
• The first phase will cover civil servants whose details were captured last year.

Medical fraud, especially in the insurance sector, has necessitated the introduction of a technology to try curb the vice. In the past, insurers used photo cards and national cards for patients to identify themselves.

This, however, was fraught with fraud in the duplication of the cards and issues about children who did not have identification cards or people bearing resemblance.

Over time, one of the products evolving in the market to arrest this was the “smart card” which has patient data and is interconnected to a biometric fingerprint scanner. It has worked well to reduce financial and billing fraud.

You not only have to be physically present but also must have your smart card to get care. The remotely monitored activity by the insurer can help track such issues. Cases where patients used to abuse photo cards and access services by pretence do not occur anymore.

While the smart card seems to be working for the private sector, adoption in public side has been slow. Until a few months ago, the National Hospital Insurance Fund (NHIF) was relying on photo cards.

In fact, 95 per cent of its members have these cards. This seems to be changing with the deployment of a biometric identification system across hospitals. The first phase will cover civil servants whose details were captured last year.

This deployment is a bold step towards reducing fraud cases. It inadvertently, however, causes reverberations across the local healthcare bioinformatics security products market.

For a long time this has been dominated by a few players with the major market share controlled by one firm.

Innovation and product penetration especially to the public hospitals and ‘jua kali’ (informal providers) was stifled because their targeted clients were corporate insurance schemes.

But if there is anything that innovation has proven, it is that technology has a way of rendering monopolies redundant. What the NHIF move means is that there is an alternative for small insurers and in-house medical schemes keen to cut costs.

Now, those owning private insurance smart cards also own NHIF photo cards; the coup will be having everyone run under a unified NHIF card interoperable with other private insurance databases.

Otherwise, the duplication of resources for IT infrastructure means parallel systems will run concurrently. Interesting times lie ahead as this war front opens up.