The State insurer has, introduced a number of new packages ranging from outpatient cover to expanded treatment for chronic diseases.
All the hospitals want to lock in the members and attract new ones, hence the facility that offers poor services would be shooting itself in the foot.
We are focused on our market. We don’t ask our members whether they have another insurer or not
Kenya is making strides towards universal healthcare for its 46 million citizens by end of 2019, following in the footsteps of countries like Japan, which adopted the policy in 1961.
But the country has yet to achieve that goal, with the National Hospital Insurance Fund (NHIF) — the agency created in 1966 to drive the universal health agenda — has in the past been embroiled in controversies to the detriment of Kenyans.
The State insurer has, however, more recently been fashioning itself as a revamped agency, introducing a number of new packages ranging from outpatient cover to expanded treatment for chronic diseases.
The Business Daily caught up with the new NHIF chief executive Geoffrey Mwangi to discuss the agency’s plans for universal healthcare.
Here are the excerpts.
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Many Kenyans are still locked out of medical cover while those covered feel the services are wanting despite the NHIF continuing to deduct monthly contributions. What’s the way out?
First of all, we have more than doubled the beneficiaries of the NHIF medical scheme over the past three years. We now have 6.1 million members who can access hospitals for both inpatient and outpatient cover — which was introduced in 2015 for private sector workers.
Our goal is to achieve universal access in the next two to three years.
Indeed we continue to receive a few complaints about the quality of medicare provided in some hospitals that have subscribed to the NHIF scheme. We are in talks.
But then again, the medical scheme we are running has a self-check mechanism in the sense that patients who feel shortchanged by the hospital they have chosen under NHIF are free to leave the hospital and register with another one. This in essence means loss of business to underperforming hospitals.
(The national health insurer pays Sh1,200 annually as capitation to a facility that the contributor and his or her family have chosen and where they are given access to services).
All the hospitals want to lock in the members and attract new ones, hence the facility that offers poor services would be shooting itself in the foot.
The NHIF in 2015 increased the monthly fees it collects from Kenyans from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month, promising them unfettered access to all hospitals. Two years on, why can’t private sector employees access outpatient care in top private hospitals?
It’s true we have faced challenges in convincing top private hospitals, most of whom are based in Nairobi and are less than six, so the impact of them not taking up our outpatient scheme is small.
A majority of hospitals, over 800, have since accepted and NHIF members can access both inpatient and outpatient healthcare there.
Remember these top private hospitals have for years controlled the market provided by private insurers and they have been under the impression that there is no incentive for them to adopt an outpatient scheme by a public insurer. But this is changing. MP Shah in Nairobi has since signed up to both inpatient and outpatient covers and we expect others like Aga Khan and Nairobi to take the cue.
Besides, we plan to roll out a co-paym
How did you arrive at the Sh1,200 capitation to hospitals?
We involved a number of actuaries in arriving at the rates, and took into account myriad considerations like how many times Kenyans fall sick per year versus costs involved.
The pooling of cash means both the poor and the rich can access unlimited outpatient cover as part of our journey towards universal access. In our view, it’s the best market rates where everyone benefits.
Do you see a point at which you will raise the capitation and subsequently members’ contributions as claims grow?
That’s not our concern now and remember such a decision has to go through Parliament first for approval. But it’s true the rates need to be adjusted for inflation, and so may be in future that will be up for discussion and implementation.
We have also recently witnessed an explosion of claims driven by lifestyle and chronic diseases. But that has not weighed heavily on us to warrant a review of the rates.
There have been concerns that some private doctors are unnecessarily pushing women under NHIF cover into having C-section surgeries for higher pay. Are you aware of this?
Indeed we are aware. This is global issue, not just in Kenya. It’s a WHO (World Health Organisation) issue. As NHIF, our position on the issue has not changed. We encourage our women to have normal delivery. In fact we don’t provide cover for elective CS operations.
What happens in the event that an NHIF member also has a cover with a private insurer? Who foots the bills or how do you share the medical burden?
We are focused on our market. We don’t ask our members whether they have another insurer or not. It’s the members to decide from whom to get medical cover.
