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Patients can now breathe easy as NHIF, hospitals resolve rates row

 

Health CAS Mercy Mwangangi and NHIF board chair Lewis Nguyai at NHIF Headquarters, Upper Hill, Nairobi. January 31, 2022. [ Jenipher Wachie, Standard]

The National Hospital Insurance Fund (NHIF) cardholders can now breathe a sigh of relief after private hospitals and the Ministry of Health agreed to resolve a pay standoff that has been going on for a while.

Private hospitals had threatened to stop treating patients using NHIF cards.

The matter was resolved yesterday after an extensive meeting that brought together representatives from the ministry, NHIF, and private hospitals.

The meeting was called following a standoff between NHIF and the private sector over new contracts.

Private hospitals had maintained that the payment remitted by NHIF was too little to offer quality healthcare as it had been reduced by at least 50 per cent.

Owners of private hospitals lamented that the NHIF, for instance, proposed remitting Sh19,000 for three dialysis sessions - which is a World Health Organisation standard - instead of two.

Private hospitals were also demanding that NHIF remits between Sh60,000 and Sh120,000 for surgical removal of an appendix as opposed to Sh40,000 that NHIF was proposing.

Mercy Mwangangi, the Health Chief Administrative Secretary (CAS) said the ministry was doing its best to ensure the delivery of affordable services.

“We have reached an agreement that there will be no halting of services by the private sector and people should not be worried. We will be coming up with how payment rates will be done,” said Dr Mwangangi.

NHIF had signed a three-year contract with private hospitals and faith-based health providers which expired in June 2021. It was extended by the government to January 31, 2022.

The meeting resolved to extend the contracts until the end of June.

New contracts will be drawn between the public health insurer and private hospitals stipulating the standard fee for doctors and healthcare. The new contracts will be effected from June 1, 2022.

 NHIF board chair, Lewis Nguyai, said contracts between NHIF and other service providers will be signed after March, while the new contracts will be used for the next five months, to give room for talks. 

Dr Abdi Mohammed, the chair of the Kenya Association of Private Hospitals said there is a need to continue offering healthcare without affecting business operations.

 The move was celebrated by the Health Renal Society of Kenya chair Dr John Gikonyo who said the end of the stalemate was a relief to kidney patients.

“Dialysis is a very expensive procedure,” said Dr Gikonyo “and we hope that NHIF expands its cover to cover post-transplant medicine.”  

 

NHIF board chair, Lewis Nguyai. [Jenipher Wachie, Standard]

Under the new contract, NHIF has established comprehensive and non-comprehensive contracts, with every hospital expected to choose which contract fits them.

Patients with comprehensive cover will not pay any money while seeking services, while non- compressive holders will have hospitals charge the amount they can afford to pay.

But irrespective of the cover, the reimbursement will remain standard across all hospitals, a move that might affect high-end hospitals which have previously been charging patients more.

The new scheme of standardising medical bills is aimed at attaining the Universal Health Coverage (UHC).

According to NHIF CEO, Dr James Kamunyo, patients will be the main beneficiaries under the new standard fees set in the new contracts.

Dr Kamunyo told The Standard in an interview that medics who were sabotaging the new fee structures were against it for personal reasons as they have been benefiting from NHIF.  

A report released last year titled, Wrong Prescription- The Impact of Privatising Health Care in Kenya, noted that out of Sh14 billion the NHIF spent annually on medical claims in Nairobi alone, Sh11 billion went to private hospitals.

The report by the Economic and Social Rights Centre-Hakijamii, Centre for Human Rights and Global Justice at New York University School of Law (CHRGJ) also indicated that privatisation of healthcare in Kenya negatively impacted the roll-out of Universal Health Coverage (UHC).

But the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) Secretary-General Dr Davji Atellah said the government should inject more funds into healthcare.

Currently, he said there is an equal share in service provision between the private and public sectors in the provision of healthcare.

“There is a need for the government to employ more healthcare workers- doctors, nurses, clinical officers among other health professionals, for smooth service provision in public hospitals,” said Dr Atellah.

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