The decision by the Association of Kenya Insurers (AKI) —the industry’s ’ lobby — to review the pricing of bills at a number of private hospitals is not only welcome but also timely.
The move comes in the wake of revelations that the Nairobi Women’s Hospital management had inflated bills to optimise profits.
The unethical and immoral practices by private investors who are profiteering from the sick is not only threatening the stability of the insurance companies, but also the wellbeing of Kenyans who rely on them for healthcare.
In their quest to prop up their financial performance, some private health providers have been overprescribing drugs to patients, which may put their lives at risk.
Doctors have also been accused of engaging in fraud by colluding with pharmaceutical firms to fleece insurance providers, further exposing the rot in the sector.
According to Jubilee Insurance, Kenyans in 2018 paid at least 50 percent more for their medications due to over-prescription of branded drugs as opposed to the use of less expensive but equally effective generic drugs.
That private hospitals’ executives put pressure on staff to meet targets, forcing them to inflate the cost of treatment exposes the gaps in regulations that have allowed the vice to thrive.
Falsified claims and the high cost of drugs prescribed by doctors have pushed the majority of medical cover providers into losses, putting the stability of the industry in jeopardy.
Only six medical insurers posted a profit in 2018, underlining the burden of rising medical bills.
Other agencies should join hands with AKI to bring sanity in the sector and save insurance companies from perennial losses.
Errant hospital executives should face the full force of the law while regulatory and licensing bodies must discipline health practitioners engaging in the acts.
For private sector players in the health industry, the Nairobi Women’s Hospital woes opens an opportunity to improve their service delivery and ensure their operations meets corporate governance standards.