The National Hospital Insurance Fund (NHIF) paid Sh5.9 billion in members’ medical bills in the four months to October, more than half of it going into surgeries, the agency said.
NHIF chief executive Geoffrey Mwangi said chemotherapy, radiotherapy, dialysis and diagnostic tests such as MRI and CT scans also made it to the list of top claims.
“Surgeries are more expensive even if less are done. We have over 15 minor surgeries, for instance, to cater for in that package,” Mr Mwangi said.
Official records show that Sh3.1 billion was paid out for specialised, major and minor surgeries alone during the review period, easing the cost burden on Kenyans undergoing surgical procedures in local hospitals.
Chemotherapy and radiotherapy accounted for Sh769 million while magnetic resonance imaging (MRI), computed tomography (CT) scan and dialysis took out Sh264 million.
The NHIF started covering surgical treatment of up to Sh500,000 per procedure last October after signing contracts with more than 2,000 hospitals, including the high-end private ones such as Aga Khan, MP Shah, Nairobi and Mater.
Between October 2016 and June 2017, the State-owned insurer had spent Sh200 million on heart surgeries alone, highlighting the growing cases of lifestyle diseases among Kenyans.
Contributors to the fund enjoy benefits of up to Sh1.5 million for heart operation.
The surgical package, which includes cancer surgeries and brain procedures, is seen to constitute real value for money for the more than 6.5 million NHIF members whose monthly contribution rose by up to 1,000 per cent early this year but with a thin range of benefits accruing from it.
The workers’ monthly contributions to the fund rose from Sh320 to between Sh500 and Sh1,700 in April based on an individual’s pay scale with the promise of enhanced outpatient benefits in both public and private hospitals.
Many households resort to holding fund-raisers to cater for specialised treatment and the after-care expenses. Standard inpatient payouts accounted for Sh57 million while outpatient payouts for the same period stood at Sh2.7 million.
The NHIF’s records also show that Sh39 million was paid to hospitals which conducted deliveries for mothers under the national free maternity programme – a Jubilee government flagship programme.
The NHIF payouts for the programme last year stood at Sh28 million, indicating an increase in the number of mothers enrolled in it.
“Registration of expectant mothers stood at 16,519 in September, up from 12,186 the previous month. In July we had only 10,874 mothers enrolled to the programme but now we are covering more of them and guaranteeing quality of care through the programme,” said Mr Mwangi.
The NHIF pays Sh2,500 for normal delivery at health centres and dispensaries, Sh5,000 in hospitals and Sh17,000 for referral facilities such as Kenyatta National Hospital for arising complications.
It also covers Sh17,000 for Caesarian-section - surgical operation to help deliver a baby - in Level Four and above facilities.