NHIF claims for C-section births hit Sh2.5bn last year


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

The National Hospital Insurance Fund’s (NHIF) pay-outs for Caesarean-section births hit Sh2.5 billion last year amid concerns that hospitals could be pushing women to surgery for financial gain.

Official records show that C-section (CS) — a surgical operation to help deliver a baby — accounted for 44 per cent of NHIF’s maternity costs of Sh5.67 billion.

NHIF data show payments for C-section has more than doubled over the past five years, underlining how widespread its use has become in Kenya.

The fund does not pay for elective C-section.

Private hospitals have been accused of pushing women into CS births because the procedure generates more money for doctors and the institutions compared to natural births.

In 2015, the NHIF board increased the amount allocated to CS births from Sh18,000 to Sh30,000.

The fund pays Sh10,000 for normal delivery having increased it from Sh6,000.

The increase in amounts payable for the procedure is seen to drive more women to opt for C-section, making it affordable to a larger number of expectant mothers who previously had to top up for the operation.

Private insurers just like NHIF do not cover elective CS fretful of its cost implications and only pay for emergency cases.

But the insurance firms only cover emergency cases up to some point and limit it for the first operation, with the insured member required to pay out of pocket.

Top private hospitals charge more than Sh200,000 for CS compared to between Sh100,000 and Sh120,000 for normal delivery. World Health Organisation (WHO) warns that the procedure — which has become the most common surgery globally — is increasingly being used when unnecessary.

“Although it can save lives, Caesarean section is often performed without medical need, putting women and their babies at risk of short and long-term health problems,” WHO says.

The jump in C-section comes in a period when the NHIF is mulling over cutting some benefits including renal dialysis, major surgeries and diagnostics tests such as MRI and CT-scans in a drive to reduce payouts.

The State-backed insurer’s cost-cutting drive will reduce payouts to hospitals by at least Sh2.9 billion in the year to June 2022, forcing thousands of beneficiaries to top-up for their medical bills.

NHIF has opted to main the average payout for C-Section at Sh29, 385 and Sh10, 000 for normal delivery in a review that will apply from next year if approved.