Proposed law to lead to overhaul of healthcare fund

The National Hospital Insurance Fund (NHIF) could undergo an overhaul if a proposed law is passed.

According to the Statute Law Miscellaneous (Amendment) Bill, NHIF will not only change its name but also expand its revenue base to include contributions from county governments.

The proposed changes to the NHIF Act, 1988 are contained in the Statute Law Bill, 2018 proposed by National Assembly Majority Leader Aden Duale.

The changes have caused apprehension among the MPs who warned that if enacted, the Bill will create avenue for corruption and abuse of power.

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The Bill also proposes a new way of replacing Board representatives of professional associations, unions and faith-based organisations, among others, with ministerial appointees.

Some MPs also fear that it will introduce double taxation on employees.

Another issue of concern is the proposal to expand the amount of money available for reimbursements as well as help improve access to healthcare for members as one of the pillars of Universal Health Coverage (UHC).

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Increase in funds

If enacted, the health insurer will see an increase in available funds at its disposal, while reducing the oversight function of external stakeholders on the board.

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More than 6.5 million Kenyans are currently contributing to the insurer and the number is expected to increase to 12 million with those from the county governments joining in.

“We are trying to amend the Act to do a number of minor things. Change the name to ‘National Health Insurance Fund’ and also enable the Fund to receive contribution from the national government, the county government and employees for the administration of employees’ benefits,” Duale said.

“We are expanding it so that members of the county government, national Government and other Kenyans can access the Fund.”

Ordinarily, such a bill is meant to make minor adjustments to laws, including changing certain terms to conform with what is currently prevailing, and correcting inconsistencies in law that make it difficult to implement.

MPs Robert Pukose (Endebess), James Nyikal (Seme), Geoffrey Odanga (Matayos), Omboko Milemba (Emuhaya) and Joseph Oyula (Butula) opposed the replacement of representatives of Cotu, medics, the Kenya Union of Post Primary Education Teachers (Kuppet), Federation of Kenya Employers (FKE) and the Kenya National Union of Teachers (Knut) and replace them with a group of five people only selected by the Cabinet Secretary.

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“These are very important sections of the formal employment and service provision. I do not know how we can run the NHIF without those being members,” Dr Nyikal said.

“What is being proposed is to have five members appointed by the CS in a way that is not clear. If you look at the whole membership, you may reach a point where the Government has enough quorum in the institution to call a meeting.”

This means all government officers can pass or change management or whatever they want to do without getting contribution from the stakeholders, as it should be, Nyikal said.

“The five people will make a quorum for decisions within the Board of the NHIF. This means we shall have a situation where people will be taxed without representation,” Milemba said.

He expressed a concern that the proposals now bring out the original understanding of how the institution has been run over the years. “There are several groups of workers represented within the NHIF by various labour organisations."

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Dr Nyikal warned the changes sought will have major effects. “We are changing structures of boards as it is being proposed for the Fund. We are changing modes of appointments of officers as put down in law."

The MPs backed the proposal to change the name to ‘National Health Insurance Fund’.

“I think this is a good improvement. It will not be a question of NHIF covering only hospitals but health of Kenyans,” Pukose said. “This is in line with the Big Four Agenda by the president on provision of universal healthcare. Therefore, this is a very important amendment.”

Milemba said the Bill seeks to expand the NHIF to cover members who have no capacity to pay.

“That is a very good proposal, and it is welcome,” he said.

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Universal healthNational Hospital Insurance Fundtatute Law Miscellaneous (Amendment) BillStatute Law Bill