NHIF Building in Nairobi's Upperhill. FILE PHOTO | NMG
Patients using insurance cards are charged up to 50 times more
than those paying in cash for the same procedure at the same hospital.
The
highly exaggerated cost of healthcare by health service providers when
they bill patients with insurance cards is a cause for worry within the
Ministry of Health.
A recently released report by the
Ethics and Anti-corruption commission (EACC) revealed that there is
widespread variation in what different hospitals charge for the same
medical procedures.
In the report, a surgery to remove
the urinary bladder for example can cost Sh7,500 for cash paying
patients but the price can shoot up to Sh90,000 for National Hospital
Insurance Fund (NHIF) and other insurances.
An insurance card holder can also pay as much as Sh35,000 for
removal of a nasal pack yet the same services typically cost a cash
paying patient Sh700.
The same differential pricing is
witnessed for a caesarean section client who will pay Sh20,000 for the
services while a card holder will be slapped with a Sh90,000 bill.
Free services
In
Nyeri County for example, a facility offers free services for children
below five years while another charges children who were covered by
NHIF, the report revealed.
Efforts to reach the NHIF
CEO Geoffrey Mwangi for comment were futile however a top official at
the fund said that health service providers are engaging in fraud.
“This
is not fair and we pay the hospitals within two weeks to a month so
they cannot say that they charge exorbitant prices because they offer
services on credit,” he said.
EACC Chief Executive
Officer Halakhe Waqo said that the Ministry of Health needs to come up
with a plan within the next month on how they will develop and
operationalise guidelines for fees to be charged on various categories
of patients.
“The pricing malpractices are shocking and
even if the institutions say that they are out to make profit this is
simply unethical and needs to be stopped,” he said.
Address the matter
Health
Cabinet Secretary Sicily Kariuki said that the ministry would urgently
interrogate the matter adding that it may impede on the attainment of
the Universal Health Coverage goal set by the President.
“Kenyans
deserve better and service providers cannot be pricing products at
their discretion, things will have to change,” she said.
Association
of Kenya Insurers, the umbrella body of all insurance Executive
Director Tom Gichuhi said that the unfortunate malpractice in the health
sector is unjustifiable.
“The only area that does not
vary in prices as much is the consultation fee which has been
standardised and the best way is for government to come up with charges
for health services for hospitals that fall within a certain bracket,”
he said.
He said that insurance companies, hospitals,
and doctors should negotiate the price for each and every medical
service even as the insurance company tries to keep costs down by
leveraging its customer base.
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