The country is staring at a healthcare crisis following a move by private hospitals which constitute an estimated 50 per cent of the country’s health care infrastructure to reject the implementation of the State-run National Hospital Insurance Fund.
NHIF rolled out the new outpatient health cover on July 1 after years of rendering only in-patient cover. But in what threatens to scuttle the roll-out of universal healthcare to all Kenyans, a key plank of the Vision 2030, private hospitals listed by the government to offer treatment to NHIF contributors have been turning away patients seeking treatment under the health plan arguing the Sh1,200 capitation per member prescribed by the fund for a whole year is unrealistic and unworkable.
Dr John Nyaumah, the chairman of Kenya Association of Private Hospitals (KAPH), a national association of medium and small private hospitals in Kenya, said yesterday private hospitals had taken the drastic decision “because of the economic reality of the matter.”
They want NHIF to review upwards the capitation per patient to between Sh6,000 and Sh10,000. Spot check by the People Daily in various parts of the country confirmed that patients could not obtain outpatient treatment from private hospitals using the cover.
A doctor in a private hospital, who sought anonymity, said the Sh1,200 fee set aside for offering the service is too meagre to sustain the cover. “How would I treat a patient with Sh1,200.
Consultation fee is Sh300 in a community-based private hospital, running a lab test amounts to Sh500, and medicine for, say, malaria or a person with severe pneumonia would cost Sh2,000. This is not enough and compromises healthcare completely,” she said.
The private players claim an independent study apparently commissioned by the government and conducted by fund managers Alexander Forbes had corroborated their claims the current caps cannot cater for effective healthcare for contributors.
“The study recommendations which the government has been reluctant to implement have shown that about Sh20,000 a year is the ideal cap to cater for an individual patient,” said Nyaumah. “What we are saying is that even if the government has no money to provide this service, they can come to the table and discuss how an appropriate figure can be arrived at.”
However, the deadlock is likely to persist after NHIF maintained yesterday the demands by the hospitals are unsustainable and unrealistic. “What they are demanding is unsustainable. We would close shop if we reviewed the caps upwards as they want us to,” said NHIF chief executive Simon ole Kirgotty.
He accused the private healthcare providers of conspiring to push the government into introducing additional monies which would overburden contributors. “We are appealing to them to understand the situation.
We understand they are proposing that we introduce a co-payment of about Sh200 which would be charged to members every time they visit the hospitals but we will not be bulldozed into this,” said Kirgotty. However, private hospitals warned that the hard-line stance by the government would jeopardise State plans to roll out universal healthcare.
Nyaumah maintained the private players would only consider implementing the plan if NHIF reviews the caps upwards. “The figure could be Sh10,000 or below. All we are telling the government is come to the table we negotiate,” he said, even as the private hospitals maintained they will stop at nothing but upward review.
A stakeholders’ crisis meeting has been called for Thursday where the healthcare providers will present their case before NHIF. Kirgotty dismissed the assertions saying NHIF had continually looked at avenues to improve the Fund.
He said a planned actuarial study had pointed to the need to increase rebates for hospitals which treat patients under the inpatient scheme to offset the financial burden hospitals are facing. “Depending on the level of the hospital and the type of contract we have signed, we plan to increase rebates for the hospitals from by Sh1,400 to incensitise the hospitals,” he said.
Nyaumah further accused NHIF managers of being rigid, adding that countries such as Malaysia, Singapore and China had, with a health service coverage rate of more than 90 per cent, illustrated that Universal Health Coverage is a goal that can be embraced and indeed achieved by countries such as Kenya.
Monthly NHIF contributions are compulsory for formal sector workers. Workers in the informal sector can also apply voluntarily, including those who have retired. The NHIF management adopted new rates in a gazette notice of February 6, 2015.
The outpatient cover was rolled out last month after NHIF began collecting higher rates from contributors to support the outpatient cover. Among the touted benefits of out-patient cover services include family planning, drugs, general consultation with general medical practitioners, prescribed laboratory tests and lab investigations.
Others are treatment of Sexually Transmitted Infections/Diseases, prescribed ultrasound diagnosis and X-ray, dressing and diagnostic testing, clinical counselling services, post-natal and antenatal healthcare and health and wellness education.
Previously, NHIF offered only in-patient cover including maternity and caesarean section in government hospitals, majority of mission hospitals and some private hospitals. It also covers for dialysis and family planning. Self-employed Kenyans were paying Sh160 monthly before the new rates came into effect.
They now make monthly contributions of Sh500. Kenyans working in the formal sector were paying a flat rate of Sh320 from 1988 until April 1, 2015 when the new rates kicked in. The rates had been last reviewed in 1988.
The new rates are graduated between Sh150 for those who earn less than Sh6,000 and Sh1,700 for those with a gross income of above Sh100,000. Nurses, Federation of Kenyan Employers, Central Organisation of Trade Unions and teachers union (Knut) raised questions over the new rates. Cotu later endorsed it.
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