Sh5.7bn NHIF claims crippling rural hospitals

NHIF head office in Upperhill, Nairobi. FILE PHOTO | NMG 

By LYNET IGADWAH
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Summary

• Rural private hospital operators want the National Hospital Insurance Fund (NHIF) to release Sh5.7 billion in accumulated claims which they say have crippled operations.
• Rural Private Hospitals Association of Kenya (Rupha) said it had submitted the claims through the national insurer’s online system over a year ago.
• The e-claims system at the NHIF targeted at weeding out fraud collapsed in August last year forcing it to revert to the manual processing of claims.

Rural private hospital operators want the National Hospital Insurance Fund (NHIF) to release Sh5.7 billion in accumulated claims which they say have crippled operations.

Rural Private Hospitals Association of Kenya (Rupha) said it had submitted the claims through the national insurer’s online system over a year ago.

The e-claims system at the NHIF targeted at weeding out fraud collapsed in August last year forcing it to revert to the manual processing of claims.

“The claims submitted through e-claim system estimated at Sh5.7 billion are in suspension since August last year, causing us cash flow problems,” Rupha chairman Brian Lishenga told journalists yesterday.

The association representing 253 healthcare cenres across 43 counties added that NHIF payments to hospitals has also been erratic and in minimal amounts.

The centres in rural and urban underserved populations like Kangemi, Kayole in Nairobi and Kisauni in Mombasa have been forced to lay off up to 50 percent of their staff to survive the hard economic times.

“We are worried that when the Covid-19 spike happens the facilities will not have resources to attend to patients,” said Dr Lishenga.

Total NHIF membership increased by 10.5 percent to 8.5 million in the year to June last year.

Contributions grew by 22.0 percent to Sh58.0 billion while payouts to hospitals increased by 36.8 percent to Sh53.4 billion.

NHIF members -especially the voluntary contributors- have defaulted on paying their premiums amid layoffs, pay cuts and unpaid leave.

The default rate in the voluntary Sh500 per month contributions category was already high before Covid-19 was reported in the country in March.

The Covid-19 spread is currently at the community level, with the country expecting a surge in infections in September.

As at June, only five counties had complied with President Uhuru Kenyatta’s directive to have at least 300 hospital beds for Covid-19 response.

Council of Governors chairman Wycliffe Oparanya said the immediate goal was to reach a target of 30 active isolation facilities each with a 500-bed capacity “but most counties are still lagging behind”.