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Why private hospitals need NHIF support in quest for quality service

A nurse attends to a patient at Mathari Consolata Mission Hospital in Nyeri. NHIF should allocate funds to  help private hospitals offer affordable healthcare. PHOTO | JOSEPH KANYI
A nurse attends to a patient at Mathari Consolata Mission Hospital in Nyeri. NHIF should allocate funds to help private hospitals offer affordable healthcare. PHOTO | JOSEPH KANYI 

A look at data from the National Hospital Insurance Fund (NHIF) indicates a few positives.

First, the publication of online financial reports for easier public scrutiny is a step in the fight for transparency. One only hopes that the content does not suffer from the “cooking” that is emerging as a disease in corporate Kenya.

The available statement of accounts shows a growth of 10 per cent in revenue. No doubt this is not only due to the increased premiums but also more members enrolled.

The figures given a few days ago show that its membership is just shy of the six-million mark. Coincidentally, the NHIF is also one of the few insurers with an assured annual member growth in the bruising medical insurance field.

All these suggest that the public’s lukewarm reception to the scheme because of the previous exclusion of outpatient care is changing, especially for those unemployed.

As a rural doctor the scheme has a good feel about it. Currently, it is on course towards enlisting 10 million members by 2020 if the current growth is sustained.

That said, however, a few things need to be looked into to build on the foundation the one year of the revamped scheme’s operation has laid.

Presently, most of the reforms going on seem to be focused on the clients or patients’ side: that is the demand component.

Little remains on be talked about on the supply side: the medical service providers or MSPs as we call them in the ecosystem. Of importance is the crucial role this group plays towards the smooth rolling-out of a vibrant and long-term medical insurance scheme.

NHIF patients’ hospital experience as a factor in deciding if they will continue paying their premiums is a key goal to be looked into.

While the scheme has been engaging with the umbrella union, not much headway had been made in negotiations with regards to fees paid to them and promptness of payments.

A scrutiny of the 2014 financial year report indicates a surplus of close to Sh800 million on collections of about Sh12 billion. With the anticipated rise in premiums collection to more than Sh30 billion this figure could be higher.

One recurring complaint is that the rates reimbursed to MSPs are too low, especially for the outpatient scheme. To ensure better delivery of health services the NHIF needs to see how it can support private sector MSPs as partners as well.

Support for MSPs has been skewed towards the public hospitals which have received ambulances, beds, renovation of wards etcetera. Very little has gone the private sector way.

Medics at MSPs are committed to delivery of healthcare at rates affordable to the common mwananchi, but the NHIF must help us shoulder some of the burden.

One suggestion is that a percentage of the surplus premiums be used to offer contracted MSPs funds at low or interest free rates. In particular towards financing of expensive equipment for rural private facilities that are often underequipped.

This way the local capacity of MSPs in remote areas is improved as well as provision of quality services to NHIF clients in these areas who are after all its core target group. Evacuation of patients to foreign hospital is okay but premature.

Email: [email protected] Twitter:@healthinfoK

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