NHIF relaxes new policy on dialysis limit

National Hospital Insurance Fund chief executive officer Geofrey Mwangi addresses journalists at Crown Plaza Hotel, Nairobi, on November 2, 2017 about changes in healthcare access. The agency will continue paying for dialysis patients who need more sessions. PHOTO | SALATON NJAU | NATION MEDIA GROUP 

In Summary

• The Fund said it was demanding pre-authorisation from hospitals for any extra dialysis sessions above the maximum number per week.

By ANGELA OKETCH
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The National Hospital Insurance Fund on Thursday backtracked on its restrictive policy on dialysis services by agreeing to pay for patients who need more sessions.

But the agency insisted this will only happen if hospitals, in collaboration with the Fund, pre-authorise requests for extra sessions. This, it says, will also tame fraud.

The Nation learnt on Thursday that some of the patients who had been turned away for exceeding the maximum eight sessions per month covered by the national insurer had been recalled.

FRAUD
One of them, who had featured in our story on Wednesday, was delighted to know that she could exceed the stipulated number of sessions.

“I am happy that they listened to our plight and are able to help,” she said.

The push to allow her to continue receiving treatment appeared to have been fronted by her employer, a government agency, that wrote to NHIF asking for a reversal of the controversial policy.

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The Fund, whose chief executive officer is Geofrey Mwangi, had started limiting the number of dialysis sessions per patient because some hospitals were billing for sessions that never happened.

A source explained that the Fund reasoned that, since most of the patients who need dialysis go for two sessions a week, capping the monthly frequency at eight would address the care needs of the majority.

Those who needed more had to consult with their hospitals, who would then seek NHIF's authority to proceed.

“Even those who need 10 sessions will get them, but only after approval by the Fund,” said the source.

PATIENTS
The Nation on Wednesday revealed how thousands of patients with kidney problems will be forced to pay extra money for dialysis every month after the national health insurer, which has been bearing the burden, started limiting the number of sessions.

The Fund said it was demanding pre-authorisation from hospitals for any extra dialysis sessions above the maximum number per week.

With more than four million Kenyans living with kidney ailments last year, the rescinded directive means hundreds of thousands of patients who require more than two dialysis sessions a week would have to start paying for the extra service or live with the pain.

POVERTY
The NHIF argued this is not a new policy, but a guideline that had been ignored in the past.

The process of seeking pre-authorisation, though, could either delay or deny poor patients life-saving treatment.

The agency did not respond to the criticism officially, but a source indicated that some hospitals have not been advising their patients to seek pre-authorisation for extra dialysis sessions because they are eyeing the more lucrative and immediate cash payments.