NAIROBI, KENYA: The National Hospital Insurance Fund (NHIF) last week issued new guidelines regarding outpatient health cover for its more than 6.5 million members.
Members could now visit any hospital or health centre of their preference unlike the past when coverage was limited to a list of providers.
More significant to members, however, was a follow-up change of policy from NHIF; visits would now be capped to just four per card holder per year.
“To the members, there is no change because the benefits package is the same,” NHIF Chief Executive Officer Geoffrey Mwangi told journalists during a media briefing before the deal was suspended by Health Cabinet Secretary Dr Cleopa Mailu. “But to the provider, we have changed from a capitation model to a fixed fee for service model.
That is the only change so our members should feel no change.”
Besides curbing fraud, Mwangi noted that the move is justified by statistics stating that the average person visits an outpatient medical center a maximum of four times each year.
However, NHIF is downplaying the impact the decision to cap members’ hospital visits will have on the poor, elderly and young children. NHIF covers more than 6.5 million Kenyans and millions of their dependents.
According to a 2015 policy brief by the Kenyan government, donors USAID and the President’s Emergency Plan for AIDS Relief (PEPFAR), the average number of visits to outpatient health centres per capita increased by 35 per cent from 2007 to 2013. According to the report, the average number of times Kenyans visit a healthcare center has gone up from 1.9 per year in 2003, to 3.1 times per year in 2013.
Conversely, the number of Kenyans reporting some sickness and not seeking treatment went down from 22.8per cent to 12.7per cent.
This points to rising demand for outpatient services and NHIF’s decision to cap the number of hospital visits is counter-intuitive.
Reports have also indicated that the youngest and oldest segment of the population (0-4 years and over 65 years) were the largest consumers of outpatient services.
NHIF’s outpatient policy will hit poor and young families hardest as well as the elderly who all form the bulk of the scheme’s membership.
The 2017 edition of the Economic Survey from the KNBS states that the total NHIF members’ contributions more than tripled from Sh9.3 billion in 2013 to Sh28.5 billion in 2015/16.
The proportion of the benefits to members relative to the members’ contributions has, however, declined from 62 per cent in the 2011 financial year to 36 per cent last year.