Kenyatta National Hospital is seeking upward review of the National Health Insurance Fund (NHIF) rebates to at least Sh39,000 per bed, citing accumulation of daily losses resulting from the high cost of treatment.
The national insurer currently reimburses the national referral facility at rates as low as Sh4,000 per bed in general wards and Sh17,500 for specialised treatment.
Acting KNH chief executive Evanson Kamuri told Parliament on Thursday that East Africa’s biggest referral hospital is owed Sh947.4 million by NHIF in unpaid reimbursements as at end of June 2019.
“The balance due from NHIF as per KNH records is Sh947,439,663 while NHIF books show the balance due to KNH as Sh842,442,947,” Dr Kimuri told Parliament.
The hospital has written to both the Principal Secretary in the Ministry of Health and the NHIF management to push for an upward review of the rate of reimbursement for specialised medical procedures.
“At KNH, we deal with complicated cases but the ministry and the NHIF have set reimbursement figures of about Sh4,000 for ICU, burns, new born, screening and ultra sound. “In a normal day, ICU bed will cost Sh50,000 but we still get a rebate of Sh4,000 per day. We end up getting a loss,” Dr Kimuri said.
He said KNH has presented a minimum rebate of Sh39,000 to the ministry and NHIF for consideration which the hospital believes will help it break even.
Currently, NHIF reimburses the KNH Sh17,500 for specialised treatment, including maternity care.
“We are in an engagement with NHIF. We have come close to an agreement and KNH’s loss making situation could change,” Dr Kimuri told the National Assembly’s Public Investment Committee (PIC) chaired by Mvita MP Abdulswamad Nassir.
He said KNH has been receiving low reimbursements from the NHIF despite treating patients who incur very high medical costs.
Dr Kimuri told MPs that NHIF owes the hospital Sh323 million that has remained outstanding since 2013/14 financial year but the hospital is in talks with the medical insurer to ensure it is settled.
Mr Nassir demanded to know how KNH has managed to plug the gap between the actual medical cost of treating a patient and the low reimbursements by NHIF.
“That is where the problem is. We don’t ask patients to pay the difference between the actual cost of treatment and NHIF rebates because most of them are indigents. The indigent bills have continued to rise risen because we do not receive any funds from the Exchequer to meet the difference,” Dr Kimuri said.