Health

NHIF members to get specialised treatment in top private hospitals

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A specialist attends to a patient undergoing dialysis. The decision comes as relief to the more than two million NHIF members, whose monthly contribution rose by up to 1,000 per cent without a corresponding increase in the range of benefits. PHOTO | FILE

Kenya’s top private hospitals have started offering National Hospital Insurance Fund (NHIF) contributors treatment for special medical conditions, unlocking a year-long standoff that had frustrated the public insurer’s plan to increase the range of services available to its members with last year’s steep increase in monthly contributions.

The decision comes as relief to the more than two million NHIF members, whose monthly contribution rose by up to 1,000 per cent without a corresponding increase in the range of benefits.

The NHIF had, for instance, promised contributors the inclusion of outpatient services and specialised treatment such as cancer therapy and kidney dialysis on the menu of services available but most upmarket private hospitals had rejected the plan following differences over the pricing of the services.  

Nairobi’s Mater Hospital has announced that NHIF cardholders can now access MRI diagnostic services and dialysis at the facility while Nairobi Hospital, Aga Khan and MP Shah Hospital said patients can now use NHIF membership cards to access chemotherapy and kidney treatment.

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The move is expected to increase access to specialised treatment in private hospitals and reduce the burden on the few public referral hospitals who have been dealing with long queues of patients.

NHIF acting chief executive Geoffrey Mwangi said that the agency had concluded its long-drawn negotiations with the top-tier hospitals, including Nairobi Hospital, MP Shah, Mater and Nairobi West to offer treatment under the new scheme.

“It is a benefit package we are offering all our members to help them manage these chronic conditions. The hospitals have been enlisted and given offer letters depending on the facilities that they have,” Mr Mwangi said, adding that not all hospitals can offer MRI diagnosis, cancer and kidney treatment.

Mr Mwangi said that while contributors do not need to subscribe to one facility to access the treatment, “it was expected that patients would use the same hospital once they begin treatment.”

To access the services, contributors have to make a formal application to the NHIF indicating which hospital they would like to be treated from.

The NHIF will then conduct a search of the member’s records and upon completion issue the hospital with a letter of guarantee allowing the contributor to access the treatment from the facility.

In addition to the pre-authorisation form, patients are also required to present their NHIF and national identity (ID) cards to the hospitals at the beginning of the treatment.

The statutory medical scheme, which is compulsory for all formal sector workers, collects up to Sh1.9 billion a month.

New contributors to the NHIF scheme can only access medical services with the membership cards three months after enlisting.

Those seeking diagnostic services such as MRI or CT scans will be covered up to a maximum of Sh25,000, while kidney patients have access to two weekly dialysis sessions priced at a maximum of Sh9,000 per session.

Those in need of a kidney transplant will also have their costs covered to a maximum of Sh500,000. The deal also offers big relief to cancer patients whose treatment will be covered to the tune of Sh150,000 per cycle.

The Aga Khan University Hospital Mombasa branch is already offering relief to residents of the coastal city who have been travelling to Nairobi for treatment.

Patients seeking kidney treatment under the cover are entitled to two dialysis session per week, medication as well as a free blood test and consultation with a nephrologist every month paid for by the NHIF while cancer patients are covered for chemotherapy treatment, including pre- and post-chemotherapy medications.

Mr Mwangi said NHIF contributors can access similar services at the two government-owned referral hospitals — Kenyatta National Hospital (KNH) in Nairobi and Eldoret’s Moi Teaching and Referral Hospital.

Kenya has only 23 nephrologists in the public service against the four million Kenyans known to suffer some form of kidney ailment.

About 8,000 kidney patients seek dialysis treatment at KNH. Approximately 39,000 new cancer cases are reported in Kenya every year and the country is estimated to lose over 50 people daily to various forms of cancer.

KNH charges Sh5,000 per session of cancer radiotherapy while private hospitals like MP Shah, Nairobi Hospital and Aga Khan charge about Sh10,000.

A notice published by the NHIF in the Kenya Gazette in April showed that the agency had increased its cover for kidney dialysis up to a limit of Sh10,000 per session from the previous Sh2,500 while kidney transplants are covered to the tune of Sh500,000 from Sh200,000.

The public insurer also gazetted new inpatient rebates, doubling the cover for bed costs, meals and medical care to a minimum of Sh1,200 per night, up from Sh600 for members admitted to public or faith-based hospitals and up to Sh4,000 a night for those admitted to top private hospitals.

Last week Health secretary Cleopa Mailu said plans were underway to increase the cover limits for cancer patients under the scheme as has been done for kidney patients.

More than 10,000 Kenyans travel abroad each year in search of treatment for various ailments, especially cancer and kidney transplants, at an estimated cost of Sh11.24 billion.

Last year the NHIF announced that it would from February this year start paying up to Sh5 million in hospital bills for members with chronic illnesses seeking treatment abroad.

Rather than be put on waiting lists in the ill-equipped public hospitals for months, many low-income households opt for donations from family and friends to finance the cost of treatment abroad.

Monthly contributions to the NHIF last year increased from Sh320 up to a maximum of Sh1,700 based on each contributor’s pay, enabling the health insurer to introduce outpatient services on top of in-patient care which was already running.

The NHIF medical cover has been limited to basic ailments like malaria, cuts and burns, pneumonia and typhoid while excluding chronic diseases.

Private hospitals have, however, rejected the Sh1,200 cash allocation that the NHIF has offered to pay as annual fee (capitation) for every beneficiary, saying it is too little.

“The larger hospitals are yet to start offering the outpatient services to the contributors although they are offering this for civil servants. We are still ironing out some issues,” Mr Mwangi said.

READ: NHIF contributors still locked out of major hospitals