NHIF to pay up to Sh5m for members treatment abroad

The National Hospital Insurance Fund (NHIF) is set to start paying up to Sh5 million in hospital bills for members with chronic illnesses seeking treatment abroad.

The move could significantly ease the burden for many households that are pushed to the brink of bankruptcy while seeking foreign treatment for their loved ones, mostly in India.

Only sicknesses that cannot be treated locally due to lack of equipment or specialised doctors such as cancer, and brain, liver and kidney ailments will qualify for treatment abroad.

“From February our members will receive treatment abroad of up to Sh5 million for chronic diseases and Sh1.2 million for other ailments,” said NHIF chief executive Simeon ole Kirgotty, adding that the foreign bill payment is one of the benefits of the higher monthly premiums introduced in April.

The NHIF, a legally established medical scheme that is compulsory for all formal workers, in April raised monthly premiums from Sh320 up to a maximum of Sh1,700 based on a member’s income.

The increased premiums were meant to give members access to both inpatient and outpatient treatment, but most top private hospitals have rejected the plan complaining that the amount the NHIF allocated to them was too little.

The selection of foreign hospitals that will be on the NHIF’s shortlist will begin Monday through a tender.

The plan could offer a big relief for Kenyans who mostly rely on contributions by friends and relatives to finance the cost of treatment abroad.

Low-income households often depend on the few cheaper but ill-equipped public hospitals where they are put on waiting lists for months before they can access treatment such as chemotherapy.

The NHIF previously used to pay bed charges for in-patient care only.

“The fund is undertaking a pre-qualification for competent and experienced overseas treatment facilitation service providers,” says tender notice published in Monday’s newspapers.

Mr Kirgotty said that the fund will require a written proof from the Director of Medical Services indicating those seeking NHIF financial help for treatment abroad cannot access it locally.

The NHIF is mostly looking for deals with hospitals in Turkey and India — which have a wide pool of specialists and advanced medical equipment but offer services at lower rates compared to hospitals in Western Europe or the US.

There has been an increased flow of Kenyans seeking treatment abroad, especially in India.

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Kenya has a relatively poor public health infrastructure, plagued by a shortage of doctors, a lack of essential drugs and medical equipment.

For instance, there are only 12 oncologists (cancer specialists) in the public sector. The NHIF has managed to collect additional billions from the higher monthly contributions with the promise of enhanced benefits, including the introduction of outpatient services.

But the implementation of the scheme, which is part of the government’s strategy to achieve universal healthcare, has not been smooth.

Private hospitals have continued to reject the Sh1,200 cash allocation that the NHIF has offered to pay as annual fee (capitation) for every beneficiary, describing it as too little.

As a result, thousands of private sector workers cannot access outpatient medical services at top private hospitals using the State health insurer’s cover.

Civil servants and members of the disciplined forces, however, continue to enjoy inpatient and outpatient services at both public and top private facilities as well as limited cover for treatment abroad.

More than 10,000 Kenyans travel abroad each year seeking treatment for various ailments, especially cancer, with government statistics indicating that this costs Kenya about Sh10 billion annually.

Kenyans are turning to India for specialised treatment, especially for heart, cancer, liver and kidney related ailments because the Asian country has some of the best doctors and advanced medical equipment globally.

“We don’t have the capacity to do liver transplant and rare brain surgeries like brain stem,” says Kanyenje Gakombe, the chairman of the Kenya Association of Hospitals (KAH).

Lack of PET scan machine — used to detect cancer and the stage of the disease — is also driving patients abroad.

Cancer is the third leading killer disease in Kenya after malaria and pneumonia, according to the 2015 Economic Survey. Official data shows that reported deaths from cancer have been on the rise recently, climbing from 11,995 in 2010 to 12,574 in 2012 and 14,175 last year.

The World Health Organisation reckons that of the approximately 41,000 Kenyans diagnosed with cancer annually, about 28,000 die.

Deaths from malaria, HIV/Aids and tuberculosis have been declining over the same period, reflecting the public health crisis brought home by cancer at a time when the country is reeling from a shortage of doctors and equipment that can handle the deadly disease.

Besides lack of medical equipment, doctors link the push to seek treatment abroad to the rising cases of rare cancers that local medics lack the expertise to treat such as rhabdomyosarcoma, which attacks muscle tissues.

Local doctors are mostly skilled in dealing with breast and prostate cancer. Some Kenyans also turn to foreign hospitals when diagnosed with late-stage cancer while others fly out in the quest for multiple opinions amid concerns over misdiagnosis in local hospitals.

Only two public hospitals — Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital in Eldoret — have the capacity to conduct kidney transplants at subsidised rates.

Patients have to wait for at least two months at KNH for kidney transplants due to a backlog.

Private hospitals charge about Sh1.8 million for transplants while KNH asks for Sh500,000. Indian hospitals charge about Sh2 million, excluding travel and accommodation that might push the cost above Sh2.5 million.

“Kidney transplant in India is more expensive than it is locally but it seems Kenyans feel more secure in the hands of foreign specialists,” said Antony Were, the head of Renal Department at KNH.