NHIF to replace oncology cover with a cancer care plan

Cancer patients under the national health insurance provider will soon have their treatment covered in full.

The National Hospital Insurance Fund (NHIF) has announced plans to reorganise its cancer insurance plan so as to pay for the entire treatment and care, instead of limited prescriptions.

This will see NHIF increase the number of cycles covered for chemotherapy and radiotherapy.

According to NHIF claims and benefits manager Judith Otele, the new proposals, once approved by the Ministry of Health, will reduce cases of patients defaulting on treatment once their covers run out.

“We have witnessed such cases, and it has had a big impact on our clients. This is why we are looking into a cancer care plan and not just covering treatment cycles like we do now,” said Otele.

Current situation

Currently NHIF covers up to 20 radiotherapy sessions at Sh3,600 each or Sh18,000 per week.

Some cancer patients are prescribed for up to 36 radiotherapy sessions and have to either pay for the extra sessions from their own pockets or drop out of treatment.

For those in need of Piston Emission Tomography (PET), a diagnostic scan introduced by Aga Khan Hospital this month, NHIF has capped the cover at Sh69,500.

First line chemotherapy is capped at Sh25,000 per session, which depending on the severity of the cancer, can cost up to Sh150,000 per session.

Ms Otele said some patients, who pay the lowest amount of Sh500 per month, cannot afford full cancer treatment.

The new proposals have already been received by the Ministry of Health. The national insurer is waiting for protocols on how to expand the cover and rebrand it to cancer care.

In the financial year 2017/18, NHIF spent Sh1.3 billion on cancer covers, which is 11 per cent more compared to the previous year.

Financial hardships

Numbers given by the insurer show that at least 68 per cent of families with cancer patients experience financial hardships, 53 per cent of patient recovery is affected by lack of funds, while six per cent of families sell assets to offset bills.

One in four uninsured patients delay cancer diagnosis and treatment.

According to the Health ministry, cancer kills 33,000 people in Kenya every year and about 48,000 new cases are diagnosed in the same period.

The ministry's head of curative services, Dr Isaac Odongo, described cancer statistics in the country as worrying.