How healthcare will change after President Ruto’s UHC rollout

The National Hospital Insurance Fund building in Nairobi. FILE PHOTO | NMG

Parliament is this week expected to pass four critical health Bills, setting the stage for President William Ruto to sign them into law and allow the rollout of his administration's universal health coverage (UHC) plan.

The 2023 Bills are the Social Health Insurance Bill, Primary Healthcare Bill, Facility Improvement Financing Bill, and the Digital Health Bill.

Below are notable changes expected in the country’s legal framework that governs the provision of public health services once the Bills are signed into law in the current state.

Common data pool on patients for contracted health facilities

The State will create an integrated information system to hold patient data, allowing healthcare providers to be contracted under the new national health insurance to access.

The integrated digital health information system to be under the watch of the Digital Health Agency is meant to reduce the requirement for patients to undertake fresh tests that hospitals do in the absence of patient medical history. Availability of the data is also key to helping cut costs of medical claims on the new fund that will replace the NHIF.

The common data that must be aligned with the data protection law will also allow access to confidential patient information to health facilities outside Kenya, upon getting the green light from the yet-to-be-formed Digital Health Agency.

Travel health insurance for all visitors

Kenya will now join the ranks of developed nations such as Dubai and those in the Schengen zone in making it compulsory for all visitors to have travel health cover.

Visitors will be free to choose a private insurer that must be recognised in Kenya. The Health Cabinet Secretary will under the Social Health Insurance Act, 2023 determine the minimum cover that the visitors will be required to hold.

Travel medical insurance helps cover the cost of many emergency medical treatments during a trip. Kenya says that the new requirement will help cover visitors in cases of emergency health risks.

Penalties for Kenyan adults for failing to make monthly contributions

Every Kenyan aged 18 years and above will be required to make monthly contributions to the fund that will replace the NHIF.

Those who fail to pay their monthly health premiums will be fined the equivalent of two percent of the defaulted amount for the period that it remains unpaid. This fine is in addition to being locked out of government services.

Cover on chronic illnesses

Kenyans will for the first time enjoy limitless insurance to pay for the entire duration of treating terminal illnesses. This will be through the planned Emergency, Chronic and Critical Illness Fund.

Patients will continue to access costly services such as dialysis, chemotherapy and radiotherapy in public hospitals once they exhaust their limits in private facilities. The fund will be one of the three kitties under the Universal Health Care.

Enhanced cover for ex-government workers

Retired civil servants who may not have private insurance will enjoy enhanced benefits and packages subject to approval from the Cabinet Secretary for Health. The enhanced cover will also apply to public servants who may not have private insurance.

The Social Health Authority

The Social Health Authority (SHA) will replace the National Health Insurance Fund, once the Social Health Insurance Act, 2023 comes into force.

SHA will have three separate funds, the Primary Healthcare Fund, the Social Healthcare Fund and the Emergency, Chronic and Critical Illness Fund.

Unlike the NHIF, the new authority will be barred from investing money in profit-making ventures such as government securities. Parliament has changed the law on grounds that the new fund is not expected to have any surplus cash given the anticipated funding demands.

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Note: The results are not exact but very close to the actual.