660 private hospitals plan to ditch NHIF over pay row

The National Hospital Insurance Fund building in Nairobi. 

Photo credit: File | Nation Media Group

Over 660 hospitals plan to withdraw outpatient services for members of the National Hospital Insurance Fund (NHIF) in protest following a mismatch in capitation rates and delays in signing contracts.

The facilities under faith-based organisations and the Rural Private Hospitals Association (RUPHA) say NHIF branch offices are asking for invoices quoting Sh1,000 rather than the agreed Sh1,400 per beneficiary per year.

The healthcare providers also note the insurer is yet to distribute physical contracts for the 2022-2024 cycle exposing them to potential legal hurdles.

“We are in a state of limbo as to whether we should serve NHIF outpatient or not because we run the risk of not being paid adequately,” said Dr Samuel Mwenda, the chairman at the Kenya Faith Based Health Services Consortium (KFBHSC).

The consortium and RUPHA have given the NHIF until tomorrow and Thursday respectively to address their concerns failure to which they warn health services will suffer.

According to soft copy contracts agreed upon by the NHIF and healthcare providers, capitation amount payable to level four and five hospitals is Sh1,400, which is equivalent to Sh350 per beneficiary per quarter.

NHIF branch managers are, however, asking healthcare providers to share invoices using the rate of Sh250 per beneficiary per quarter that is equivalent to Sh1,000 per beneficiary per year.

Dr Mwenda said the information the facilities were receiving informally was that the Sh1,400 will be allowed only for patients with chronic illnesses.

Capitation, just as is in the case for schools, is paid in advance and is based on the number of NHIF members assigned to a particular health facility.

“We are in the second month of the quarter and health facilities have not received their capitation resulting to inordinate inconveniences,” said RUPHA chairman Dr Brian Lishenga.

RUPHA represents 367 healthcare centres in rural and urban underserved populations such as Kangemi, Kayole in Nairobi and Kisauni in Mombasa

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