The universal health care agenda comes with a number of lessons that could boost access and service provision. FILE PHOTO | NMG
Increased publicity
around Universal Health Care (UHC) has raised awareness and visibility
of the National Health Insurance Fund (NHIF) product.
But
is that incentive enough for people to enroll to the scheme? Taking cue
from similarly aligned strategies elsewhere, notably studies on the
impact of premium costing, deadlines and penalties on enrollment, we
could borrow a leaf or two.
Findings on reasons for
enrollment show that the scope of diseases covered, compensation levels,
pricing of premiums and claims settlement timelines to providers are
the biggest influencers. Based on these and other parameters, the NHIF
can judge its product.
Amongst jua kali and low income
contributors with erratic wages, the consequence of late premium
contributions and penalties creates an inescapable mix that prevents
their re-entry to safety coverage.
Penalties, while aimed at guaranteeing the funding cycle,
actually have negative repercussions amongst such groups. For instance,
how long does it take to get a defaulted client across each premium band
back to good standing? Secondly is there a penalty fee such a defaulter
is comfortable to rejoin the scheme?
Such statistics
are unavailable, but the NHIF just like banks and mobile lenders, ought
to have data on these to guide on its strategies.
A
debate arises on which approach between encouraging saving for insurance
or facilitating borrowing for payment of premiums works best. The fact
though is that for Kenya’s lowest income earners, saving seems to be
harder than borrowing.
To
fix this, suggestions gleaned from interventions elsewhere show two
approaches can be taken. The first one is to entice this bottom of the
pyramid groups to see the value of enrolling. Here easing the process
has been noted to work. Secondly supporting them to avoid lagging behind
on premium payments and the inevitable punitive penalties meted out
also works. These two combined make a big difference in retention rates.
Amongst
certain income groups, saving for health is an almost impossible task.
Yet often their health expenditure is out of pocket at “private
facilities” usually at higher costs and maybe paid for from borrowed
funds.
If our ultimate aim is to get net-creditor
groups insurance, is facilitating low interest rated loans for premium
payments worse to punitive default fees? The UHC agenda gives a win-win
opportunity for our financial sector to strategise on how to chip in
while tapping in to the 48 million Kenyans and over Sh30 billion fund
for this band.
They can design products to lend for NHIF premium for those at risk of penalties and defaults.
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