Looming health crisis over NHIF-private hospitals charges disputes
Private hospitals and National Health Insurance Fund (NHIF) are in a standoff after the former has threatened to deny services to patients depending on the insurance.
The Kenya Association of Private Hospitals (KAPH) threatened those private hospitals countrywide will, from Monday, deny services to patients depending on NHIF.
Dr. Timothy Olweny, the KAPH Secretary General, told a local Tv station that they have reached the decision to protest NHIF’s treatment of private hospitals when it comes to claims settlement.
“Come Monday, January 31, which marks the end of our seven-month extension of contract with NHIF, we, the private hospitals, won’t be in a position to offer services to patients depending on NHIF,” he said.
According to Olweny, the new contracts were hurriedly drafted without adequate time for perusal and implementation would be counterproductive.
In a previous structure, NHIF would pay Sh9,500 for each dialysis session. Dialysis patients require at least two sessions a week.
In the new contract, NHIF says it would charge Sh6,500 per session.
“The charges are even lower than what was proposed by the Kenya Medical Practitioners and Dentists Council (KMPDC) in 2016. We are not going to sign the new contract until they are reviewed,” he said.
Olweny says private hospitals would lose at least Sh6,000 per patient per week, if the insurer was to stick to the new rates.
He says some of the services, whose costs have been significantly slashed, include surgical services and dialysis.
“They reduced surgical package charges by as much as 50 per cent. That can’t be justified,” he said.
Olweny said private hospitals charge between Sh60,000 and Sh120,000 for the surgical removal of tonsils from a child.
“However, NHIF remits a maximum of Sh32,000 to private hospitals for the service. That’s way below the amount of money that the Kenya Medical Practitioners and Dentists Council recommends,” he said.
For caesarean section, an obstetrician is supposed to charge Sh96,000 or maximum Sh180,000 and anaesthetists fees minimum Sh30,000, or a maximum of 60,000 but NHIF in their new review wants patients to pay Sh20,000 for everything.
The new contract says hospitals must not co-charge patients anything beyond what NHIF pays.
However, not many public hospitals offer dialysis services prompting patients to move to the private hospitals.
The government is in the process to provide additional dialysis and theatre equipment to 15 hospitals under the Managed Equipment Scheme (MES) project.
MES committee is adding dialysis and theatre equipment to enable the hospitals to cope with the increased number of patients.
The hospitals set to benefit from this proposal are Kenyatta National Hospital, Moi Teaching and Referral Hospital, Nakuru County Referral Hospital, Kakamega County Referral Hospital, Othaya National Referral Hospital.
The formal sector accounts for 3.25 million people out of which 64.6 per cent who are active members of the NHIF.
The informal sector has 1.78 million people with 35.4 per cent of them being active members.
