Editorials

Hospitals, patients must be honest to tame bills

KMNH

Kenyatta National Hospital. FILE PHOTO | NMG

That employers have once again reported a disproportionately big leap in medical bills for staff is unfortunate.

Industry statistics show that a steep increase in claims pushed up medical costs for 14 Nairobi Securities Exchange-listed companies 11.23 per cent last year.

These firms paid out a total of Sh3.7 billion last year or Sh400 million more than the previous year’s medical bills – a significant increase in a year by any standards.

While the insurance industry is yet to produce its latest report, we can always be sure that nearly all the medical service underwriters have registered huge financial dents as well. More than half of Kenya’s 32 medical insurance firms posted a Sh621.64 million loss in 2016 in sync with healthcare costs which surged 10.2 per cent to Sh54.8 billion that year.

Staff medical cover is a welfare issue and nobody would make a fuss if the whole expense was incurred in defraying the actual bills. Not so in this case.

Both the corporate insurance schemes and individual insurance policies have in recent times been plagued by fraud perpetuated by entities which should otherwise be the ones to prevent such scams.

Hospitals and doctors are known to inflate fees, order unnecessary tests and prescribe expensive drugs to patients just because they are on corporate medical schemes.

And more often than not, patients tend to be the willing accomplices in the crime as long as they don’t have to pay the bill out of pocket. Patients not only abet fraud when they fail to question the need for the various tests ordered but also when they facilitate identity theft to enable third parties to use their cards.

If technology could eliminate fraud, most firms – employers and insurers – have tried their best, including the introduction of biometric cards but to no avail.

It turns out that honesty, integrity and truthfulness must count in every sphere of human relations.

Character starts by acknowledging that corporate-sponsored scheme is a privilege in this disease-plagued part of the world. It is a fact that employers and insurers need to be encouraged to include more ailments in their medical cover, by keeping claims down.