NHIF claims down Sh4.5bn on reduced hospital visits


NHIF Building in Upper Hill, Nairobi. FILE PHOTO | NMG

Medical claim payouts by the National Hospital Insurance Fund (NHIF) dropped by Sh4.51 billion in the year to June, the first dip in 15 years, as patients avoided hospitals for fear of contracting the coronavirus.

Data by the NHIF shows that Sh52.04 billion was paid out in medical claims in the year to June 30, down from the Sh56.55 billion spent in the previous period, helped by reduced hospital visits.

The eight percent drop in claims paid out came in the period hospital visits dropped 60.4 percent to 1.871 million from 4.724 million in the previous financial year.

Insurers have for long been at loggerheads with hospitals over allegations of fraudulent claims and inflated bills.

Outpatient visits fell from 2.81 million to 1.23 million while hospital admissions dropped to 638,470 from 1.5 million, reducing NHIF payouts.

This is the first time in 15 years NHIF payouts have declined. The payouts last dropped by Sh8 million in the financial year ended June 2006.

The average number of days a patient spent in the hospital during the financial year under review was 2.2 compared to 3.8 in the previous similar period.

The trend mirrors that of private insurers where reduced hospital visits helped the medical underwriters return a Sh1.3 billion underwriting profit in the year ended December from a Sh75.14 million loss in 2019.

Official data by the Insurance Regulatory Authority (IRA) shows that claims rose three percent to Sh21 billion and premiums increased six percent to Sh44.9 billion.

The reduced hospital visits, however, dealt a blow to health facilities which reported reduced revenues, prompting some of them to carry out layoffs and salary cuts.

Reduced payouts helped take pressure off the NHIF, which posted a drop in premium collections on the back of a Covid-19 economic fallout that saw a half of registered members default on payments.

The NHIF closed June with 10.13 million members and 13.37 million dependents, translating to coverage of about 49.3 percent of the total population.

“This shows that several Kenyans have high exposure to out-of-pocket expenditure, thus are vulnerable to severe consequences of healthcare access and utilisation that are especially catastrophic for the poor,” says the NHIF.

The formal sector, where members pay between Sh150 and Sh1,700 per month depending on the salary scale, had 4.54 million members while the informal sector had 5.59 million members.

However, 5.1 million or 50.3 percent of the total NHIF members were actively paying premiums, leading to a drop in premiums collected by the fund.

Some 1.29 million or a quarter of formal sector members were inactive while 3.81 million or 74.7 percent of the total informal sector members were not contributing their Sh500 monthly premiums.

“The informal sector has the lowest active membership of 74.7 percent due to individuals in the informal sector defaulting in payments, being accelerated by the effects of the Covid-19 pandemic,” says the public insurer.

Defaulted contributions saw premiums collected in the financial year ended June fall from Sh58.61 billion to Sh57.18 billion—marking the first decline in 18 years.

The collected premiums translated to 89 percent of the Sh64.49 billion that it had hoped to collect in the financial period on the back of increased members.

The NHIF closed the year with a loss ratio — claims paid and expenses as a portion of earned premiums— of 91 percent, down from the previous financial year’s 93 percent.

Kenya has prioritised the attainment of universal health coverage (UHC) by 2022 after years of false starts.

The State wants a mandatory UHC national scheme for all Kenyans regardless of the economic status and is counting on the NHIF to manage it.

It has offered to sponsor one million poor households at the onset of the UHC scheme.

The parliamentary committee on health recently threw a spanner in the works, striking out clauses in the NHIF (Amendment) Bill that sought to introduce mandatory contributions by all Kenyans above 18 years.

The Treasury said in February Budget Policy Statement for the fiscal year 2012/2022 that plans to roll out the State-backed health insurance were at an advanced stage, with the collection of the beneficiaries’ data already underway.