Private hospitals reject Sh1,200 NHIF cash allocation

Private hospitals have rejected the Sh1,200 cash allocation that the National Hospital Insurance Fund (NHIF) has offered to pay them as annual fee for private outpatient treatment, saying it is too little.

Through their lobby, the Kenya Association of Private Hospitals (Kaph), the private facilities on Friday said the proposed annual cover per beneficiary of the State-backed scheme cannot sustain their operations.

The NHIF has capped the annual benefits for out-patient services at between Sh1,200 and Sh1,400 depending on the hospitals.

“The low capitation (allocation per member) makes this scheme not viable. We will not sign up if nothing changes,” Kaph chairman John Nyaumah said in an interview.

Dr Nyaumah said that the low rates limit patients only to minor healthcare and locks them out of diagnostic services that most prefer in the better equipped private facilities.

The Sh1,200 limit also falls short of consultation fees in most private facilities, not to mention diagnostic charges and prices of medicines.

The association represents more than 300 hospitals including Nairobi, Aga Khan, Mater, MP Shah and Gertrude’s which are yet to sign up.

The lack of a deal means contributors remain confined to medical care from public hospitals for services they were supposed to start enjoying on July 1.

This is despite an increase in workers’ monthly contributions to the fund from Sh320 up to Sh1,700 in April based on their pay scale.

Dr Nyaumah said that they had proposed to the NHIF a minimum of Sh6,000 in annual capitation.

The national health insurer had promised contributors that they would get access to private hospitals once the monthly deductions were increased.

READ: No services in top hospitals yet for NHIF contributors

Samuel ole Kirgotty, NHIF’s chief executive, however, sought to justify the outpatient covers, saying that the capping in capitation was based on studies that established how often Kenyans seek medical care.

“Hospitals will continue getting the cash they are entitled to based on the number of contributors who have registered with them, regardless of whether services are sought or not,” said Mr Kirgotty.

“On the other hand the pooled cash will ensure universal healthcare to all households.”

Mr Kirgotty said that the capitation limit would be reviewed after six months. The annual Sh1,200 cover is per person in a household, meaning the scheme will favour homes with many people.

Workers in private firms contributing varying monthly cash under private medical schemes enjoy outpatient cover of up to Sh100,000.

The Consumer Federation of Kenya (Cofek) challenged the NHIF, saying contributors were getting a raw deal and that the scheme was a rip-off.

“This is a drop in the ocean. It beats the logic of having raised workers’ monthly contributions for a cover of Sh100 per month,” said Cofek’s secretary-general Stephen Mutoro.

“Which sickness can Sh1,200 cover in private hospitals in a year? We are going to challenge this in court,” he said, adding that the NHIF should have reached a deal with the facilities before rollout of the scheme.

The consumers lobby group said that the low rates only serve to further amplify the attitude of those seeking services under the NHIF scheme as “second-rate patients”.

Dr Nyamu pointed out that the Sh1,200 cover is not enough for an appointment with a private doctor, let alone medical care.

State-owned Kenyatta National Hospital’s private wing, for instance, charges Sh1,000 plus a one-off filing fee of Sh450 for first-time patients.

Nairobi Hospital charges Sh2,000 for outpatients to consult a doctor, MP Shah (Sh1,400), Karen Hospital (Sh1,800) while Aga Khan University Hospital levies Sh1,940. Gertrude’s consultation fee stands at Sh1,550.

Employers and civil servants through their unions have also opposed the enhanced contributions.

The pooling of cash is part of the government’s strategy to achieve universal healthcare, which is part of the country’s Vision 2030 development blueprint.

The NHIF said it had collected Sh3.2 billion since April to be paid to the hospitals as capitation.

The public health insurer last month published a list of about 1,128, private and faith-based health service providers that it said had agreed to serve contributors to the enhanced scheme.

The top private hospitals were, however, not on the list but the fund said it had opened negotiations to get them on board.

Enjoyment of enhanced benefits, including outpatient services was supposed to have begun on July 1, three months after the fund started collecting the higher premiums.

NHIF members earning between Sh50,000 and Sh59,999 in April started remitting Sh1,200 to the enhanced benefits scheme while the self-employed are paying Sh500 up from Sh160 a month.

Workers earning Sh5,999 and below are paying Sh150 to the fund every month while earning Sh100,000 and above remit the highest amount of Sh1,700, a 431 per cent increment.

Unlike the past where the NHIF only partially paid for inpatient services, contributors are now entitled to outpatient services in addition to inpatient care in facilities that are divided into three categories.