A showdown looms in the health industry after insurance companies threatened to increase their premiums if medical fees and charges are not reduced.
During a public consultation organised by the Consumers Federation of Kenya, companies which offer medical insurance said if the fees charged by doctors were not revised, they would increase the premiums.
A premium is the amount an individual or a business pays for an insurance policy.
Once it is paid, the insurer must provide coverage for claims made against the policy.
“The sector is already bleeding from the high costs of healthcare. Given the small number of insured Kenyans, we might soon have to increase our rates,” Ms Jemimah Mbugua of Resolution Insurance said.
According to the latest report by the Association of Kenya Insurers, only 19 out of 37 insurance companies in the country provide medical cover.
The report says that the number of Kenyans buying medical insurance is dwindling.
The total amount in premium covers bought in 2017 was about Sh38.4 billion, compared to Sh38.8 billion in 2016, it says.
The report adds that it was the first time medical insurance had recorded a decline since 2013.
“Only about three per cent of Kenyans have medical cover other than the National Hospital Insurance Fund. The doctors fees in its current form will put insurance out of reach for many,” she added.
Ms Mbugua questioned the separation or unbundling of charges, saying insurers were making losses due to exorbitant bills.
“I do not see the need for a doctor to separate procedure costs whenever he or she performs a double surgery on the same patient at the same time,” she said.
Doctors have, however, opposed a review of medical fees.
They even declined to attend the meeting organised by Cofek and the Kenya Medical Practitioners and Dentists’ Board (KMPDB).
While admitting that the government has the authority to set fees in public hospitals, they said it has no mandate to intrude in doctor-client matters.
Last month, the National Assembly asked the board to review doctors’ fees and replace the current “exorbitant” charges gazetted in the 2016 professional fees guidelines.
According to a 2016 gazette notice, the minimum consultation fee should be Sh1,800 while the maximum is Sh5,000. House visits by a doctor should cost Sh3,600 and a maximum of Sh5,000.
A visit to the hospital during the day costs between Sh6,000 and Sh120,000 while a visit at night should cost Sh12,000 to Sh18,000.
Other charges include Sh72,000 for a twin delivery, and a maximum of Sh120,000.
A Ministry of Health survey in 2017 found that at least a million Kenyans are driven into poverty every year due to high medical expenses. Some sell land, houses, motor vehicles and other assets to settle the bills.
KMPDB chairman George Magoha said there was a need for Kenyans to balance their expectations against the prevailing economic circumstances.
“It is as if we want a socialist country where everyone earns the same amount of money. Even if the fees are exorbitant, we should be realistic. I do not, for instance, expect the charges at Nairobi Hospital to be the same as those at Mater,” Prof Magoha added.