Health Cabinet Secretary Cleopa Mailu was spot on in reversing the National Health Insurance Fund’s (NHIF) decision to limit the number of outpatient claims it will underwrite.
When the NHIF announced that it would underwrite just four claims per family annually, it noted that this was out of a desire to control costs and improve the quality of inpatient services.
We believe, the introduction of these caps was ill-advised. Not only was it going to deny millions of Kenyans access to universal healthcare, it was going to compromise the health of the country’s most vulnerable populations.
The NHIF, with 6.5 million registered members, has given many poor families an avenue to cut household costs by limiting their expenditure on healthservices. Money raised by members comes from workers in the formal sector who contribute to the fund anything between Sh150 and Sh1,700 every month depending on their salary. These contributions and the Sh500 from those who are self-employed raises Sh3 billion each month.
Unfortunately much of the contributions to the fund are inefficiently managed, with about half the amount being spent on administrative costs. A sizeable amount is also spent on making payments on fictitious claims. But these are both administrative bottlenecks rather than faulty underwriting and can be tackled by introducing internal efficiencies.
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When poor people are not covered by insurance, they will make less visits to hospitals, opting to stay home until their illness is at a critical stage. In the long run, there will be a reduction in early diagnosis. The implication is that we will end up spending more money on treatment rather than preventing disease which is infinitely cheaper.
CS Mailu says the capping of visits has been suspended to allow for further consultations with stakeholders. However, we are of the view that these caps should not be reintroduced at all.
