The State will set up a special fund for the treatment of chronic illnesses in a bid to save patients from out-of-pocket payments when they deplete their medical cover and ease pressure on the national health insurance scheme.
The Chronic Illness and Emergency Fund will cushion Kenyans from costly cash payments for illnesses like diabetes, cancer and kidney failure when they exhaust their social insurance cover.
The kitty to be funded from a mix of Exchequer, levies and mandatory healthcare contributions to a national scheme is part of the Universal Health Coverage (UHC) set to be rolled out next year.
Currently, the National Hospital Insurance Fund (NHIF) has put a limit on the spending for treatment of chronic illnesses, exposing such patients to high out-of-pocket spending once they exhaust their cover.
The new fund will also ensure the sustainability of the State-owned health scheme amid struggles by the NHIF in footing treatment such as kidney dialysis and cancer, leaving patients exposed.
Acting NHIF chief executive Samson Kuhora says Kenyans seeking treatment for ailments such as cancer are required to pay about 60 percent of the costs out of pocket or Sh600,000 for a Sh1 million bill with NHIF paying the rest.
“Patients get initiated on treatment for these diseases but they do not get the intended treatment outcome due to exhaustion of their cover and also inability to make the out-of-pocket payments,” Mr Kuhora told Business Daily.
“There are conditions where as a country we have to put in investments. These include cancer, diabetes, sickle cell and cardiovascular diseases.”
Cancer patients are, for instance, covered up to 20 radiotherapy sessions a week at a cost of Sh3,600 and a maximum of six sessions for 25,000 per chemotherapy session.
For patients with renal failure, kidney dialysis is covered for two weekly sessions of Sh9,500 each, but with an annual limit while for kidney transplants, the NHIF contributes a maximum of Sh500,000.
Patients who exhaust their limits before the end of the year are forced to use cash for treatment even as they continue making premium payments to NHIF.
Treatment of chronic illnesses has emerged as the biggest claims item for the public health insurer, gobbling billions of shillings given that it is the number one cover for Kenyans from low-income homes.
The NHIF had last year sought changes to the law that would have limited funding treatment of chronic illnesses in public hospitals.
Private hospitals have over the years enjoyed increasing business from the NHIF for the treatment of chronic illnesses due to the congestion at public hospitals.
The Chronic Illness and Emergency Fund is one of the three insurance covers that will be set up under the new Social Health Insurance Scheme that will replace the NHIF.
The others are the Primary Health Care Fund, which will cover preventive and promotive care services at health centre and dispensary levels while a Social Health Insurance Fund will foot costs for primary referrals.
The three funds are contained in the Social Health Insurance Bill, 2023— one of the four State-sanctioned health Bills meant to guide the rollout of UHC.
The others are the Primary HealthCare Bill 2023, Digital Health Bill 2023 and the Facility Improvement Financing Bill 2023.
However, the financing of three funds will hit Kenyan homes with State planning contributions calculated at 2.75 percent of monthly income.
The proposed rate will increase deductions from the current range of Sh150 to Sh1,700, further squeezing the incomes of both formal and informal workers.