A Clinix healthcare facility in Embu. The hospitals association says Clinix and Meridian who have been adversely mentioned are not their members. Photo/File
Established private hospitals stayed out of the controversial National Hospital Insurance Fund medical scheme for civil servants after they failed to agree on payment.
The opting out of hospitals that wanted to be paid at least Sh6,000 per person paved the way for outlets of less capacity to draw Sh2,850 per person that was on offer, the Kenya Association of Private Hospitals (KAPH) said.
KAPH vice chairman Kanyange Gakombe said only 10 of its members accepted the rates proposed by NHIF.
“We advised NHIF of the presence of ghost hospitals. We told them that most private health facilities were unable to meet the requirements for inclusion into the new out-patient services,” said Mr Gakombe when the association appeared before the parliamentary Health Committee chaired by Dr Robert Monda.
The association wanted to be paid up to Sh9,000 per person depending on facilities.
Mr Gakombe said insurance scheme members mostly visit hospitals about four times a year during which they are charged between Sh1,000 and Sh1,500 consultation fees per visit.
The secretary general of KAPH, Mr Peter Omboga, said the hospitals that benefited from the scheme did not have the capacity to carry out the responsibilities given to them.
He said the NHIF cover could not provide unlimited outpatient services as was promised.
The association said the Meridian and Clinix group of health centres that are at the centre of claims of payments to ghost hospitals were not its members. The committee has since found out that Meridian was paid Sh116 million and Clinix Sh202 million as capitation fees for the outpatient services.
Some of the outlets have since been found to be non-existent and their medical staff unregistered by the doctors board.
Mr Gakombe said the capitation model preferred by NHIF instead of the fee for service model gave leeway to wastage of funds and poor services.
The private players say the government should calculate the capacity of every hospital in the programme and allocate funds according to ability to treat patients.
They demanded that hospitals that offer diagnosis related procedures be classified in their group while those that offer specialised treatment be allocated enough funds per patient.
Prime Minister Raila Odinga suspended the NHIF board and chief executive Richard Kerich on Monday and appointed a caretaker committee.
