In what could turn out to be another mega scandal hitting hard the National Health Insurance Fund (NHIF), Kenya seems to be the land for the rich only.
A recent report released by the actuarial review of NHIF indicated that Kenya’s top 10 hospitals take up 28 percent of NHIF contributions while a paltry 72 percent is left for other 7,990 facilities to share.
According to close sources, the top 10 facilities with just two public referral hospitals – Kenyatta National Hospital and Moi Teaching and Referral Hospital – gobbled up Sh16 billion in two financial years.
Ezekiel Macharia, the managing director of Kenbright Actuarial and Financial Services hypothesized that poor Kenyans who contribute to NHIF monthly pay for the rich to access the best of medical services in Kenya.
Mr. Macharia noted that the services rendered in these facilities are above board, therefore, the demand is high which informs their decision to increase prices and NHIF pays for this.
The report cited that the total NHIF pay-out percentage in form contributions was 86 percent. Interestingly, 80 percent of this went to private facilities which laid claim.
Of the 80 percent claims by private facilities, 48 percent were inpatient cases with the average cost capped at Sh22,000.
Parliamentary Health Committee member Dr. Eseli Simiyu (Tongaren) in response to the report’s findings asserted that NHIF needs to be overhauled to address a myriad of shortcomings that it is mired in adding that it could affect the delivery of the Universal Health Coverage (UHC)
“NHIF needs to be restructured because this is not the first time the matter is coming up,” remarked Mr. Simiyu.
Over the last two financial years, KNH got Sh3 billion from the fund while Nairobi Hospital got Sh2.85 billion. Aga Khan got Sh2.3 billion, Nairobi West Sh1.7 billion and MP Shah got Sh1.5 billion
On the top ten list also was Gertrude’s Garden Children Hospital which got Sh877 million, AIC Kijabe (Sh868 million), Texas Cancer Centre (Sh831 million) and Mediheal Hospital and Fertility Centre (Sh788 million).
Maternity services (Sh1.4 billion), renal failure (Sh408 million), influenza (Sh304 million) and Sh287 million for malaria and pneumonia cases were paid out for by NHIF.
Kenya Medical Association secretary-general Simon Kigondu, however, added that though the report has pointed to interesting data, public hospitals should be restructured to match private facilities famed for excellent service delivery.
