NHIF yet to strike deal with top private hospitals

The National Hospital Insurance Fund (NHIF) has yet to sign up top private hospitals for the provision of enhanced medical services it promised consumers in the wake of a steep increase in monthly contributions in April.

Samuel ole Kirgotty, the fund’s chief executive, said NHIF was yet to strike a deal with the industry’s leaders such as Nairobi, Aga Khan, Mater, MP Shah and Gertrude’s, signalling that contributors remain confined to care from public hospitals for services they were to start enjoying beginning July 1.

“We are still negotiating with them because their rates are higher,” Mr Kirgotty said, adding that mounting resistance to the new rates had unnerved private hospitals.

“Even those that we are negotiating with are 50- 50 (not certain),” said he said, citing the protests from civil servants.

Employers have also opposed the enhanced contributions.

The NHIF reckons that a review of monthly premiums was necessary for improvement of medical services.

The pooling of cash is part of the government’s strategy to achieve universal healthcare, which is part of the country’s Vision 2030 development blueprint.

The NHIF said it had collected Sh3.2 billion since April to be paid to the hospitals as capitation.

The public health insurer last month published a list of about 1,128, private and faith-based health service providers that it said had agreed to serve contributors to the enhanced scheme.

The top private hospitals were, however, not on the list but the fund said it had opened negotiations to get them on board.

NHIF had hoped to entice contributors, whose monthly fees increased from Sh320 up to Sh1,700, with the promise of enhanced benefits in the premium facilities.

READ: Top private hospitals missing from NHIF provider list

Mr Kirgotty did not indicate the capping for annual benefits for out-patient services – an issue that experts say holds the key to long-term survival of the programme.

Sources, however, indicated that contributors of the highest premiums (Sh1,700 per month) have their annual benefits capped at Sh1.2 million while those paying the least have a Sh30,000 limit.

Enjoyment of enhanced benefits, including outpatient services began on July 1, three months after the fund started collecting the higher premiums.

NHIF members earning between Sh50,000 and Sh59,999 in April started remitting Sh1,200 to the enhanced benefits scheme while the self-employed are paying Sh500 up from Sh160 a month.

Workers earning Sh5,999 and below are paying Sh150 to the fund every month while earning Sh100,000 and above remit the highest amount of Sh1,700, a 431 per cent increment.

The high and low-end private hospitals, which most Kenyans prefer because they are better equipped, need to negotiate a co-payment or bill sharing structure with the NHIF before signing up to the scheme.

Unlike the past where the NHIF only partially paid for inpatient services, contributors are now entitled to outpatient services in addition to inpatient care in facilities that are divided into three categories.

Public facilities such as Kenyatta National Hospital and Eldoret’s Moi Teaching and Referral Hospital are in Category A while Category B comprises faith-based health service providers.

A user does not incur any expenses if they choose to seek medical attention from public and faith-based hospitals. Medical attention from private hospitals (Category C) — which most Kenyans prefer because they are better equipped — require extra cash.

The new outpatient cover is expected to offer services like general consultation, treatment of sexually transmitted diseases, renal dialysis, X-rays and minor surgical procedures.

The NHIF has until now been providing inpatient cover to workers and is using the new outpatient services to fend off opposition to the higher monthly contributions.

NHIF contributors are currently entitled to an in-patient cover (whereby the public insurer pays a daily Sh2,400 rebate) and maternity cover worth Sh6,000 and Sh18,000 for normal and C-section deliveries respectively.

Civil servants and members of the disciplined forces are, however, covered for outpatient services through a special scheme that was launched in 2012, but was immediately hit by a mega scandal involving selection of providers.