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Concern as patients with insurance charged 50 times more than by cash

NHIF Building in Nairobi's Upperhill. FILE PHOTO | NMG
NHIF Building in Nairobi's Upperhill. FILE PHOTO | NMG 

Patients using insurance cards are charged up to 50 times more than those paying in cash for the same procedure at the same hospital.

The highly exaggerated cost of healthcare by health service providers when they bill patients with insurance cards is a cause for worry by the Ministry of Health.

A recently released report by the Ethics and Anti-corruption commission (EACC) revealed that there is widespread variation in what different hospitals charge for the same medical procedures.

In the report, a surgical operation to remove the urinary bladder, for example, can cost Sh7,500 for cash-paying patients, but the price shoots up to Sh90,000 for those paying National Hospital Insurance Fund (NHIF) and other insurance cards.

An insurance card holder can also pay as much as Sh35,000 for removal of a nasal pack yet the same services typically cost a cash-paying patient Sh700.

The same differential pricing is witnessed for a caesarean section client who will pay Sh20,000 for the services while a card holder will be slapped with a Sh90,000 bill.

Free services

In Nyeri County for example, a facility offers free services for children below five years while another charges children who were covered by NHIF, the report revealed.

Efforts to reach the NHIF CEO Geoffrey Mwangi for comment were futile however a top official at the fund said that health service providers are engaging in fraud.

“This is not fair and we pay the hospitals within two weeks to a month so they cannot say that they charge exorbitant prices because they offer services on credit,” he said.

EACC Chief Executive Officer Halakhe Waqo said that the Ministry of Health needs to come up with a plan within the next month on how they will develop and operationalise guidelines for fees to be charged on various categories of patients.

“The pricing malpractices are shocking and even if the institutions say that they are out to make profit this is simply unethical and needs to be stopped,” he said.

Address the matter

Health Cabinet Secretary Sicily Kariuki said that the ministry would urgently interrogate the matter adding that it may impede on the attainment of the Universal Health Coverage goal set by the President.

“Kenyans deserve better and service providers cannot be pricing products at their discretion, things will have to change,” she said.

Association of Kenya Insurers, the umbrella body of all insurance Executive Director Tom Gichuhi said that the unfortunate malpractice in the health sector is unjustifiable.

“The only area that does not vary in prices as much is the consultation fee which has been standardised and the best way is for government to come up with charges for health services for hospitals that fall within a certain bracket,” he said.

He said that insurance companies, hospitals, and doctors should negotiate the price for each and every medical service even as the insurance company tries to keep costs down by leveraging its customer base.

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