NHIF bills up by Sh900m under special cover

National Hospital Insurance Fund (NHIF) building.
Medical bills paid by the National Hospital Insurance Fund (NHIF) for patients undergoing special treatment have gone upby over Sh900 million in the last financial year. 

At least Sh917 million more was paid in 2017/18 for patients in need of cancer, kidney and specialised surgery treatment.

A big portion of the payouts went to renal patients in need of renal dialysis, where Sh1.7 billion was spent compared to Sh1.2 billion the previous year.

Some Sh64 million was spent on kidney transplant – capped at Sh500,000 per patient – compared to Sh27 million in the previous financial year. 

Sh100 million more was spent on cancer treatment, which went up to Sh1.3 billion from Sh1.2 billion, while Sh548 million was paid out for specialised surgeries compared to Sh274 million.

NHIF pays for up to six chemotherapy cycles at Sh25,000 per cycle – though at times patients require up to 18 – and Sh18,000 per session for 20 sessions which might stretch to 25. These charges are per patient per family in a year.

The State-owned insurer recorded a Sh10 billion increase in revenue to Sh47.8 billion from Sh37.1 billion the previous year.

While membership contribution increased to Sh32.9 billion from Sh29.8 billion, premiums from special medical schemes increased by Sh7 billion to Sh12 billion in 2017/18.

The biggest portion, however, of the average Sh34 billion bills paid in the year ending June 2018 was on free maternal programme.

According to the unaudited financial results by the NHIF for 2017/18, while the free maternal programme payouts to beneficiaries went up to Sh1.4 billion, the usual maternal services payouts went down by six per cent to Sh1.5 billion from Sh1.6 billion.

The increase can be attributed to the Linda Mama programme included into NHIF last year after its launch in 2016. The programme in its first financial year was managed directly by the government, not under NHIF, before it was incorporated into the basic insurance scheme. 

The programme provides free maternal services for all expectant women, including those aged below 18. 

One also does not need to be a member of NHIF to benefit, unlike the usual maternal services where one has to be a beneficiary or contributor to the scheme to benefit.

The reduction in payouts for maternal services and increase in free maternal payouts means most women prefer to access the free services compared to using their NHIF cards.

It is such programmes and increased payments that NHIF is banking on to declare itself ready and fit for the roll out of the Universal Health Coverage (UHC) next month. 

In the 11-page document titled ‘Strides towards UHC coverage for all Kenyans’ that contains the latest financial statement, NHIFoutlines its readiness for the Big Four agenda.

“The expanded benefits package currently offered has increased healthcare access for NHIF members and at the same time boosted the health care providers ability to provide more effective care to both NHIFmembers and the Kenyan citizen,” reads the document.

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Medical billsNational Hospital Insurance FundNHIF