In the quest to align with the National Health Insurance Fund (NHIF) Act of 2022 that provides the framework for the attainment of Universal Health Coverage, NHIF has moved to issue new rebate rates. These are the defined reimbursements for public and private health facilities that provide services for members of the fund.
In this move, the scope of services covered by NHIF has also been expanded to include additional outpatient investigations, surgical and cancer services. Also, new contracts will provide around 7,600 public, faith-based and private facilities to offer services to Kenyans.
Whereas this expansion is a welcome move in the context of increasing financial and geographic access to healthcare services, more consultations are needed.
Some service providers have decried low amounts allocated to cover key services such as deliveries (normal and Caesarian) and investigations such as MRIs. In the provision of such services, there are usual inherent costs that need to be covered by the reimbursement amounts.
These include costs of medicines, reagents, manpower, supplies and overheads. The hardest hit by this reduction are private healthcare providers who account for around 50 percent of healthcare services in the country.
The privates are harder hit because public and semi-public providers are mostly cushioned by subsidies. The fear herein is that there may occur an inadvertent shunning of NHIF patients by private providers which would defeat the purpose of this expansion.
Therefore, there needs to be wider consultations between the insurer and organisations such as Kenya Healthcare Federation and Kenya Private Hospitals Association to streamline the prescribed rebate rates. This is particularly important as the Act gives provision for all Kenyans above 18 years to be registered as NHIF members.
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