Kidney crisis triples NHIF dialysis pay to Sh3.8bn


A member of the public scans his finger during NHIF mass biometric registration in Nyeri County on June 2, 2021. FILE PHOTO | NMG

National Hospital Insurance Fund (NHIF) payments for renal dialysis have more than tripled in the last four years, highlighting the growing cases of kidney ailments among Kenyans.

The State-backed insurer paid Sh3.844 billion for 295,563 claims for patients who sought renal dialysis in the year to June as rising cases of lifestyle diseases continue to burden the fund

This represented a 208 percent jump from Sh1.247 billion the NHIF paid for dialysis in the year to June 2017.

NHIF members are entitled to two weekly sessions of dialysis that each costs Sh9,500, pushing total annual payment per patient to an average of Sh960,000.

NHIF chief executive Peter Kamunyo said a significant number of the kidney patients joined the fund after falling ill.

“We have patients paying Sh6,000 annually and receiving benefits of nearly Sh1 million per year. This is a burden to NHIF,” Mr Kamunyo said.

The scenario — called adverse selection in insurance terms— is putting at risk the ability of the insurer to settle claims and meet administrative costs.

Adverse selection refers to situations where an insurance company extends coverage to an applicant whose actual risk is substantially higher than the risk known by the insurance company.

The NHIF collected Sh61.5 billion in the year ended June and paid out Sh54.6 billion or 88.7 percent as claims to hospitals.

Mr Kamunyo said a significant number of active voluntary contributors are suffering from chronic diseases, leaving the fund with huge monthly claims.

Voluntary contributors — usually drawn from informal sector — pay Sh500 a month to the NHIF while those in formal sector contribute between Sh150 and Sh1,700 every month, depending on salary scale.

The number of voluntary contributors has jumped in recent years on the back of a mass recruitment drive.

Official data show that about four million Kenyans have some form of kidney ailment.

High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. High blood pressure, for instance, is reported to cause just over a quarter of all cases of kidney failure.

Dr Andrew Suleh, a renal expert and former medical superintendent at Mbagathi District Hospital, said that lifestyle diseases have been on the rise in the past few years on increased consumption of junk and sugary foods and people going slow on physical exercises.

“There is an increase in non-communicable diseases that include obesity, diabetes, hypertension. Obesity is linked to lifestyle and we can see there has been a proliferation in consumption of junk and sugary food,” Dr Suleh told the Business Daily Wednesday.

Renal dialysis accounted for the third biggest spending for medical bills paid through the NHIF, after inpatient services at Sh7.43 billion and major surgeries at Sh5.08 billion.

Mr Kamunyo said the problem of adverse selection will be addressed through the ongoing changes to the law that seek to make it compulsory for every adult Kenyan to be a member of the NHIF in a race to offer medical cover for all.

The government-backed NHIF (Amendment) Bill seeks to make it compulsory for every Kenyan above 18 years to contribute and be a member of the fund.

The proposed law, which is currently before Parliament, targets more than 16 million adult Kenyans who are not covered by the NHIF.

The State has offered to sponsor one million poor households at the onset of the universal health coverage (UHC) scheme, which is modelled on the US’s Obamacare that extends insurance to 32 million uninsured Americans.

Obamacare, officially known as the Affordable Care Act, requires all employers to cover their employees or pay a tax penalty, except for small firms.

The fund has disclosed that 5.7 million members or 54 percent of the 10.6 million members had stopped paying premiums by the end of last month having benefited from its services, including key procedures that come with hefty bills.