By ISAAC ONGIRI
A storm is brewing over the new multibillion-shilling health insurance scheme for civil servants, teachers and members of the disciplined forces.
Members of a parliamentary committee are questioning the National Hospital Insurance Fundâs (NHIF) choice of service providers and whether those accredited can offer the services needed. Two private healthcare chains have signed up more than 40 per cent of the 221,730 eligible civil servants.
Also raising eyebrows is the NHIFâs decision to pay accredited hospitals and clinics in full even before they deliver their services. More than Sh1.08 billion has already been sent out to 1,170 hospitals through capitation.
MPs are worried unscrupulous operators may take advantage of the pre-payments by diverting funds to other purposes or lodging fictitious claims. The legislators point out that some service providers have begun ambitious expansion plans using the pre-payments instead of spending the funds on medical services for beneficiaries. The Sh1.08 billion in advance payments, referred to as capitation, is supposed to benefit some 221,730 public servants for the first quarter beginning January 2012.
Fraudulent claims
Parliamentâs Health Committee has summoned NHIF officials next week to respond to queries over the scheme, which is expected to grow after the courts sanctioned higher deductions to employeesâ pay. The lawmakers are also planning a national tour of all accredited facilities to assess their capacity.
"This is a great idea and we insist that the NHIF must get it right," says Nyaribari Chache MP Robert Monda, who chairs the Health Committee. "As a watchdog we are going to scrutinise some of the underlying issues to ensure it works for the beneficiaries. That is why we have invited the board to come and answer some developing questions."
NHIF is preparing to collect an estimated Sh80 billion annually from contributors in formal employment to deliver an ambitious universal health insurance.
The Sh4.3 billion-a-year scheme for civil servants is expected to expand after the Teachers Service Commission signed a separate Sh4.5 billion deal with NHIF to provide cover for some 260,000 teachers.
For the civil servants, Sh1.3 billion will be spent on in-patient cover, Sh2.3 billion on outpatients, Sh646 million on group life cover while Sh84 million will cater for last expense claims and another Sh2.8 million will be spend on other levies per year.
Some MPs now fear that the NHIF may run into trouble with the experimental scheme unless standards are set for the service providers to avoid fraud or theft of billions of State funds meant to benefit Government workers.
