NHIF patients won’t get services at private hospitals starting Monday

HEALTH & SCIENCE |

NHIF maintains that its new rates will allow the insurer to increase the number of people benefiting from its services. [File, Standard]

Private hospitals countrywide will, from Monday, January 31, deny services to patients depending on NHIF, Association officials say.

The Secretary-General of the Kenya Association of Private Hospitals (KAPH), Timothy Olweny, told The Standard in an exclusive interview that they have reached the decision to protest  NHIF's treatment of private hospitals when it comes to claims settlement.

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 review, NHIF says it would charge Sh6,500 per session.

Olweny says private hospitals would lose at least Sh6,000 per patient per week, if the insurer was to stick to the new rates.

NHIF and hospitals renew terms of engagement after every three years.

The last review ended in June 2021, and the insurer has now decided to revise downwards the amount of money it pays for claims lodged by private facilities, said Olweny.

The Association had, upon expiry of their contract with NHIF in June last year, extended services by another seven months, which end on January 31, 2022.

“The engagement [over new terms] that we started having with the NHIF earlier this month have since stalled,” he said.

“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.

Olweny 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.

According to the private hospitals association secretary-general, their terms and conditions with NHIF do not allow patients to top up for services footed by NHIF.

The National Hospital Insurance Fund (NHIF) maintains that its new rates will allow the insurer to increase the number of people benefiting from its services.

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