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State insurer pays out Sh1bn for C-section deliveries

CS is one of the single largest benefits payments under the enhanced scheme. PHOTOS | FILE | NMG
A couple attend to their newly born baby: C-Section is one of the single largest benefits payments under the enhanced scheme. PHOTOS | FILE | NMG  

The National Hospital Insurance Fund’s (NHIF) payouts for Caesarean-section operations have for the first time crossed the Sh1 billion mark in a year, highlighting the cost burden of the procedure to insurers.

Official records show that 24,492 mothers opted for C-section — a surgical operation to help deliver a baby — in the first half of 2016, up from 22,411 in a similar period a year earlier, representing a nine per cent increase.

This saw the national health insurer pay Sh714.7 million in six months to the health facilities that performed the surgery, up from Sh432.1 million in a similar period the previous year.

C-sections accounted for 61 per cent of the NHIF’s maternity costs, and more than a third of the women covered by the fund opted for the operation, underlining how widespread its use has become in Kenya.

Geoffrey Mwangi, the NHIF chief executive, said payments for C-section has so far crossed the Sh1 billion mark for the first time due to increased amounts for the procedure and the large number of women opting for the operation.

“CS is one of the single largest benefits payments under the enhanced scheme,” said Mr Mwangi.

In 2015, the NHIF board increased the amount allocated to CS from Sh18,000 to Sh30,000. The fund pays Sh10,000 for normal delivery having increased it from Sh6,000.

The increase in amounts payable for the procedure is seen to be one of the factors driving more women to opt for CS – having brought on board a large number of potential users who could previously not afford it.

More accessible

The World Health Organisation in 2014 predicted that CS would become even more common in Kenya if more women could access and afford it, in spite of the procedure being unnecessary in most instances.

Use of CS to deliver babies has been rising fast among Kenyan women because it shortens labour and cuts risks of complications associated with natural birth.

Besides, private hospitals have been accused of pushing women into CS for financial reasons. This is because the procedure generates more money for doctors and the institutions compared to natural birth.

Elective operations such as CS are, however, not covered by private insurance providers fretful of its cost implications – making the NHIF the sole underwriter of the bills.

Private insurers only cover emergency cases up to some point and limit it for the first operation, with the insured member required to pay out of pocket.

Top hospitals such as Nairobi’s Karen Hospital were mid last year charging about Sh220,000 for CS compared to between Sh100,000 and Sh120,000 for normal delivery.

NHIF data shows that it paid Sh440.8 million for normal delivery in the half year period, involving 43,275 women, up from Sh273.8 million a year earlier.

The NHIF in 2015 introduced outpatient cover and enhanced benefits for ailments such as cancer and kidney dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month.

Editor's note: The story has been edited to exclude a cited 2016 study on normal deliveries after Caesarean-sections

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