A proposed amendment to the NHIF Act could see the public health insurer compelled to charge uniform fees for medical procedures and drugs across different hospitals.
Soy MP Caleb Kositany has sponsored the National Hospital Insurance Fund (Amendment) Bill seeking to standardise fees that private hospitals charge patients who pay their medical bills using the NHIF card.
“Setting standard costs will ensure that the NHIF scheme is not used for the payment of unnecessarily expensive medical procedures whose costs can be standardised,” Mr Kositany told Parliament’s Health Committee when he appeared before it to defend his legislative proposal.
Mr Kositany told the team his proposed amendment to section 22 of the NHIF Act seeks to give power to the Health Cabinet Secretary in consultation with the NHIF board to standardise costs of medical services in respect of payment of benefits.
Under the current Act, the NHIF board pays from the fund benefits to declared hospitals for expenses incurred by any contributor, his named spouse, child or orphaned dependent.
The scheme covers both inpatient and outpatient expenses.
The benefits payable are limited to expenses incurred in respect of drugs, laboratory tests and diagnostic services, surgical, dental or medical procedures or equipment, physiotherapy care and doctors’ fees, food and boarding costs.
Mr Kositany said health service providers contracted by the NHIF have been fleecing patients who present their insurance cards.
“I went for lens surgery and asked the doctor what is the cost and the doctor told me yours is insurance, what is your problem?” Mr Kositany told the committee.
He also asked MPs to look into the sustainability of the NHIF given the exorbitant charges hospitals slap on its card holders.
“We also need to look at the cost of drugs,” he said, adding that patients are billed after exhaustion of the medical insurance cover limits.
The Health committee members led by James Nyikali agreed with Mr Kositany and proposed to expand the changes to the NHIF law to create a regulatory body, modelled on the Energy Regulatory Commission (ERC) to regulate charges by private medical providers contracted by the fund to offer medical services.
“I agree with Dr Nyikal's proposals that we need to create a regulatory body to oversee what is charged by private hospitals. We want competition but we shouldn’t allow exploitation and extortion of patients. There has to be a body that can accept fair competition,” Mohamud Sheikh Mohamed, the Wajir South MP, said.
Stephen Mule said the committee has written to Health Secretary Sicily Kariuki and the NHIF management to provide written submissions on Mr Kositany’s proposal.
“Kenyans want affordable healthcare. We need to look at the NHIF law holistically to ensure that NHIF is sustainable and medical costs are reasonable. We have written to ministry to give us responses on your proposed Bill.
“We will also call NHIF and relevant stakeholders including the medical service providers,” said Mr Mule.