Many retirees have either limited or fixed incomes.
With the low pension penetration, only a limited percentage who are retired from formal employment receive a pension. Even where the retirement pension is available, it rarely accounts for the rising expenses of medical care, especially in the face of chronic conditions that tend to increase with age.
Those who are poorer without an income or those uninsured are unlikely to access quality healthcare or the care could push them to extreme poverty due to the huge bills.
The pandemic laid bare the shortcomings of our healthcare systems indicating poor preparedness in attending to the increasing demand for health care from older people who are financially unprepared for unforeseen medical bills.
Findings of a 2021 survey by Enwealth Financial Services showed that about 41 percent of retirees pay for medical bills out of pocket.
In more recent statistics, as high as 70 percent of Kenya’s elderly population relies on out-of-pocket payments for medical services, often leading to financial distress and forcing many to prioritize certain basic needs over others.
Gradually, medical care may become an essential —yet disproportionately costly— aspect of their daily lives.
Even with the popularisation of the former state health insurance, NHIF, it was not without service delays, claim rejections and limited coverage that led to out-of-pocket expenses. Outpatient services were rejected in most facilities and patients were required to co-pay for many other services.
These are some of the problems that Social Health Insurance Fund (SHIF), now Taifa Care, is being touted to solve.
The new state health insurance holds the promise of universal health coverage and so, retirees are particularly keen to know if this change will alleviate the struggles they face in accessing affordable healthcare.
In principle, Taifa Care aims to deliver a more accessible and equitable healthcare system.
A quick overview of the medical scheme’s benefits shows introduction of new services not covered under NHIF, such as screening for common health conditions and cancers. It also covers the cost of consultation, preventive, and restorative treatments like extractions and scaling, as well as resuscitation and stabilisation for critical conditions.
In addition, patients with permanent physical or sensory disabilities will be provided with necessary assistive devices.
Other key benefits of Taifa Care include increased cover limits for routine treatment like renal care and kidney transplant. In addition, the cover has standardized tariffs for surgical treatment across all health facilities unlike before where services were limited to government, faith-based and select private facilities.
These added benefits are much needed and hopefully, the country shall get over the painful implementation phase soon.
That said, though Taifa Care is designed to improve healthcare access for all Kenyans, including retirees in rural areas, the practical reality of Kenya’s healthcare infrastructure may pose challenges.
Many regions still lack adequate facilities, trained personnel, and medical supplies, limiting the potential reach of the state’s medical cover. Without significant investments in healthcare infrastructure, retirees in remote areas may continue to face difficulties in accessing quality care despite Taifa Care coverage.
In addition, administrative challenges and trust Issues still stand. NHIF has faced criticism over inefficiency, misuse of funds, and corruption, leading to skepticism about whether SHIF will truly be different. If these issues persist in Taifa Care, retirees may still face the same agonies.
The writer is the CEO, Enwealth Financial Services
