EDITORIAL: New NHIF outpatient directive discriminative

NHIF chief executive Geoffrey Mwangi. FILE PHOTO | NMG
NHIF chief executive Geoffrey Mwangi. FILE PHOTO | NMG 

For Kenyans who have followed the protracted debate in the last 10 years, the present-day National Hospital Insurance Fund (NHIF) is a stark reminder of the long journey to a universal health insurance scheme.

The country is not yet there, but reforms have enhanced access to healthcare services among families living below the poverty line.

Today, the NHIF covers elderly people for free while the unemployed and informal sector workers become members by contributing as low as Sh300 per month.

That is why we find its latest directive, which limits outpatient visits to only four per year per poor family, out of tune with the policy direction.

Without doubt, the change is discriminatory. It effectively means the poor who heavily rely on the fund for access to quality primary medical care have to lower their expectation. A family can only use the NHIF card to access outpatient services four times a year.

An average family size in Kenya of five implies that even if a family were to restrict its every member to using the shared card only once in 12 months, some will still miss out.

Yet as that happens, salaried workers – who are better placed to top up the additional charges - are allowed to use the card as many times as they wish to a limit of Sh1,500 per visit.

The privileged lot is also free to visit any NHIF-contracted hospital for outpatient services.

Granted, the Fund has argued that such restrictions allow it to put more resources into inpatient services, including specialised treatment. But how many people ever get admitted to hospital? How often do family members encounter ailments that require specialised treatment?

Whatever operational issues the NHIF is grappling with at the moment, it should not lose sight of the big picture. The idea of a social scheme is to have the well- to- do members subsidise costs for the poor.

And lest we forget, the NHIF would today be called National Social Health Insurance Scheme had the National Social Health Insurance Bill mooted in 2004 by then Health minister Charity Ngilu gone through.

Moreover, the government has every campaign year promised its citizens universal healthcare because it is uncomfortable with an arrangement where the unemployed have to pay for medical services out of their pockets.