The National Health Insurance Fund (NHIF) average spending per inpatient claimant from the informal sector has risen to Sh48,824 amid mounting defaults in premiums payment.
An actuarial report on the NHIF shows the figure, relating to the year ended June 2022, was a rise from Sh47,647 in the preceding year, bringing the total inpatient claims payment for the period to Sh16.2 billion.
The claims were paid out to 332,194 people. This means the Fund relied on the rest of the active members to subsidise those who fell sick to the tune of about eight times their annual Sh6,000 premiums.
Inpatient claims had dropped for two consecutive years to an average Sh42,642 in the financial year ended June 2020, partly on patients avoiding hospitals for fear of contracting Covid-19 but this has been rising in line with increasing claimants.
Health insurance usually relies on the concept of pooling which allows the higher costs of the less healthy to be offset by the relatively lower costs of the healthy.
However, NHIF is concerned that only 1.6 million of the 8.1 million registered members from the informal sector were keeping up with payments.
The report, prepared by Kenbright Actuarial & Financial Services, says the NHIF lost Sh39 billion in the period under review after over 80 percent of the voluntary contributors defaulted on payments.
