NHIF to publish list of accredited hospitals on May 18

The National Hospital Insurance Fund (NHIF) Thursday said it was reducing monthly fees for informal sector workers even as it promised to publish the long awaited list of accredited hospitals on May 18.

NHIF chairman Mohamud Ali said contributors would start accessing the enhanced medical services from July 1 when the agency expects to have completed due diligence on participating health service providers.

Mr Ali said households with unreliable income sources will not be required to pay the fixed Sh500 monthly fee, but will instead pay between Sh150 and Sh500 based on their financial status.

He said the public health insurer’s actuaries were working with Planning ministry officials to categorise informal sector workers for purposes of fixing the monthly contribution rates.

“Contributions by informal sector workers will be staggered from a minimum of Sh150 to a maximum of Sh500 to ensure they are not disadvantaged,” the NHIF chairman said at a Press conference, adding that it would be unfair to expect the unemployed to make higher contributions than the employed.

NHIF’s new monthly fees came into effect at the end of last month and require those earning Sh5,999 to pay Sh150 monthly -- the lowest deduction.

Those earning Sh100,000 and above are now required to make Sh1,700 monthly contribution or 431 per cent increment.

The pooling of cash is part of the government’s strategy to achieve universal healthcare by ensuring both poor and rich households access medical care that is often out of reach for the majority of Kenyans.

The NHIF said it had collected Sh1 billion as of Thursday and the officials expected the figure to hit the targeted Sh2.3 billion by Saturday. Mr Ali maintained that deductions are based on employees’ gross pay as opposed to basic salaries that employers have proposed.

The Federation of Kenya Employers (FKE) through its executive director,  Jaqueline Mugo, Thursday rejected the NHIF’s insistence on pegging the fees on gross pay.

READ: Employers want new NHIF rates pegged on basic pay

Mr Ali said that unlike the past where the NHIF only paid for inpatient services, Kenyans will from July access outpatient services in addition to inpatient care in the facilities that are divided into three categories.

Public facilities such as Kenyatta National Hospital and Eldoret’s Moi Teaching and Referral Hospital are in Category A while Category B comprises faith-based health service providers such as St Mary’s Mission Hospital in Nairobi.

A user will not incur any expenses if they choose to seek medical attention in public and faith-based hospitals unlike in private facilities (Category C) — which most Kenyans prefer because they are better equipped but will require extra cash.

The insurer said it was discussing capitation rates with the service providers in partnership with the 47 county governments.

It is, however, yet to determine the margin by which it will increase the in-patient rebate that currently stands at Sh1,900 per day and which mainly goes to settle the cost of a patient’s hospital bed.

The NHIF said those paying the highest premiums (Sh1,700 per month) will have their annual benefits capped at Sh1.2 million while those paying the least will have a Sh30,000 limit.

On February 13, the NHIF gazetted rules that require Kenyan workers earning between Sh50,000 and Sh59,999 to contribute Sh1,200 to the scheme every month and the self-employed to pay Sh500 a month up from Sh160.

The insurer reckons that review of monthly premiums was necessary for the planned improvement of services and has used introduction of an out-patient cover as the major selling point during the transition.

NHIF contributors are currently entitled to an in-patient cover (whereby the public insurer pays the Sh1,900 rebate) and maternity cover worth Sh6,000 and Sh18,000 for normal and C-section deliveries respectively.

Civil servants and members of the disciplined forces are, however, covered for outpatient services through a special scheme that was launched in 2012, but was immediately hit by a mega scandal involving selection of providers.

The new out-patient cover will offer services like general consultation, treatment of sexually transmitted diseases, renal dialysis, X-rays and minor surgical procedures.

The new scheme will cover the principal member, their spouse and an unlimited number of children aged up to 18 and 23 if they are still in college.

Each family member will independently choose their preferred hospital, with those who live away from the principal member being free to pick their own facility.

In the event of an emergency, a member will be treated at the nearest available facility with the expense later being charged to the hospital the member initially chose.

The NHIF will also come up with a list of specialised hospitals where a patient can be referred in case their hospital of choice lacks the capacity to handle them.