Private hospitals disown list of NHIF outpatient providers

Private hospitals have disowned the list of service providers that the National Hospital Insurance Fund (NHIF) published on Monday, insisting they had not struck any such deal with the public health insurer.

The NHIF published the list of more than 1,500 public, private and faith-based health service providers in a section of the press designating them as the “accredited facilities where members will access outpatient services.”

The list, which included the country’s top hospitals like Nairobi, Aga Khan and Gertrude’s Children Home, indicated that the NHIF had concluded consultations with the institutions and invited the public to choose their preferred service providers.

“The list will be available on our website and members will be required to choose the health facility nearest to them for outpatient services,” NHIF chief executive Simeon ole Kirgotty said in the advertisement.

“It is important to note that the choice of facility is only for outpatient services.”

The Kenya Association of Private Hospitals (Kaph), however, said none of its more than 300 members had signed outpatient contracts with the universal health insurer, meaning that some of the hospitals in the just-published list may opt out of the scheme.

John Nyaumah, the Kaph chairman, said the list was merely a replica of facilities that were accredited for the controversial civil servants and disciplined forces inpatient and outpatient scheme in 2012.

Dr Nyaumah denied claims by Mr Kirgotty that the NHIF had concluded negotiations with the private hospitals for provision of outpatient services under the new scheme.

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He said that a 10-member committee (made up of five NHIF and five Kaph representatives) formed last week to discuss the matter had not even held its first meeting.

“It is unprofessional for the NHIF to publish a list claiming discussions have been concluded yet we have just constituted a team to negotiate details of the partnership such as co-payment,” said Dr Nyaumah.

“The list they published is simply that of hospitals currently providing outpatient and inpatient cover to civil servants and members of the disciplined forces. The new outpatient contracts will only be signed upon successful negotiations.”

Nairobi Hospital, a member of the Kenya Hospital Association, which was listed among institutions that have agreed to offer the outpatient services said it had not concluded any negotiations with the NHIF.

“We have not signed any new contract to begin providing outpatient service,” said the hospital’s chief executive Cleopa Mailu.

NHIF members earning between Sh50,000 and Sh59,999 in April started remitting Sh1,200 to the enhanced benefits scheme while the self-employed are paying Sh500 up from Sh160 a month.

Workers earning Sh5,999 and below now pay Sh150 to the fund while those paid Sh100,000 and above remit the highest amount at Sh1,700, a 431 per cent increment.

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The NHIF has since said it has collected Sh1.5 billion against a target of Sh2.3 billion and that the money is being accumulated as a capitation pool from which hospitals chosen by contributors will be paid.

“We will be guided by the response of Kenyans on where they want to go to determine how much we shall pay hospitals in capitation,” NHIF chairman Mohamud Ali said.

The fund had a fortnight ago said the capitation model would enable it to roll out outpatient services in June but has since pushed it to July. The NHIF’s management had, at the time, indicated that the agency was negotiating capitation rates with accredited healthcare providers.

The negotiations were mainly with private hospitals because patients visiting public or faith-based hospitals for out-patient treatment will not be required to pay any extra amounts.

But high and low-end private hospitals, which most Kenyans prefer because they are better equipped, needed to negotiate a co-payment structure with the NHIF.

The fund had initially planned to limit the outpatient, inpatient and maternity services to public hospitals and low-cost private hospitals, which are not popular with the middle and upper class contributors with private insurance.

The NHIF indicated that it would lock out the high-end private hospitals like Aga Khan, MP Shah, Mater and Karen because of their relatively higher charges.

“We are in talks with the high-end private hospitals over the provision of out-patient services,” said Margaret Nzwii, the acting general manager for operations at the NHIF. “We shall be presenting them with our proposed rates and offer them a chance to sign up.”

The other category of hospitals is made up of public facilities such as Kenyatta National Hospital in Nairobi and Moi Teaching and Referral Hospital in Eldoret while the fourth category has faith-based facilities such as St Mary’s Mission Hospital in Nairobi.

The new out-patient cover is expected to offer services like general consultation, treatment of sexually transmitted diseases, renal dialysis, x-rays and minor surgical procedures.

The NHIF has until now been providing in-patient cover to Kenyan workers and has used the new outpatient services to fend off sustained opposition to the higher monthly contributions.

In publishing the new list of hospitals, the NHIF had given the impression that it had completed negotiations with the service providers – a claim that many disputed on Monday.

The NHIF’s cover for civil servants and the disciplined forces, which the agency is using as a reference for the new plan, does not exclude the high-cost facilities where the members can get benefits that are capped at the fund’s discretion.

The fund is also yet to determine the margin by which it will increase the in-patient rebate that currently stands at about Sh2,400 per day and which mainly goes to settle the cost of a patient’s hospital bed.

“We will be able to know the new rebates by the end of May,” said Mr Ali.

The new outpatient scheme will cover the principal member, their spouse and an unlimited number of children aged up to 18 and 23 if they are still in college.

Each family member will independently choose their preferred hospital, with those who live away from the principal member being free to pick their own facility.

In the event of an emergency, a member will be treated at the nearest available facility with the expense later being charged to the hospital the member initially chose.