The National Hospital Insurance Fund’s (NHIF) pay-outs for Caesarean-section births hit Sh1.2 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 58.2 per cent of NHIF’s maternity costs as a third of the women covered by the fund opted for the operation.
Geoffrey Mwangi, the NHIF chief executive, said payments for C-section surpassed budgets, underlining how widespread its use has become in Kenya.
“It is strange we are paying more for emergency deliveries given that we do not pay for elective C-section,” said Mr Mwangi, adding that the fund has started stringent vetting for the operation.
“We are going to follow the women and ask them whether they underwent the procedure because in some cases, mothers give birth normally and the doctors bill us for emergency delivery,” he added.
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.
NHIF data shows that it paid Sh895 million for normal delivery last year, involving 85,900 women compared to the 40,000 that opted for C-section.
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.
The NHIF in 2015 introduced outpatient cover and enhanced benefits for ailments such as cancer and kidney dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month.
In the six months to December, it collected Sh23.6 billion from its seven million members and paid Sh17.3 billion to hospitals as claims and used Sh3.2 billion for its expenses.
The fund closed the half-year with a Sh3.1 billion surplus.
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.