NHIF collections take a hit, leave hospitals and patients in pain

Alphonce Muasya Nzangi, a former civil servant and cancer patient was denied treatment by NHIF claiming that he had not paid up to date his monthly contributions. [Jenipher Wachie, Standard]

Crisis looms in health care following uncertainty over contributions to the national health scheme.It has emerged that Kenyans are shying away from making contributions to the National Health Insurance Fund (NHIF) as they wait for takeover of the scheme by the Social Health Authority (SHA), while others are remitting less than the current Sh500.

Sources says NHIF is now unable to meet its obligations, with hospitals demanding their dues.

A source at the Ministry of Health said the pronouncement on monthly remittance of 2.75 per cent has reduced collections.Operations at the two entities is now hanging in the balance after the courts halted the implementation of the new law.

This is happening despite high demand for services by millions of Kenyans who depend on the insurance for health care.

“Collections at NHIF have dropped and Kenyans are just shying away from registering for services,” said the source.Hospitals are struggling to offer services, with some withdrawing care to NHIF clients due to delayed payments.

Rural Private Hospitals Association of Kenya Chairperson Brian Lishenga said NHIF owes hospitals more than Sh15 billion to about 400 hospitals, an issue that he said is affecting service delivery. Some of the money dates back to 2018.

“By January 2, 2024, the government should pay our money, and if not, patients will now pay to receive care,” said Dr Lishenga.

“It is a gloomy Christmas for nurses, doctors, clinical officers and other hospital employees because they have not been paid their salaries for about three months."

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Lishenga said the hospitals had agreed to have patients pay, but were forced to hold on after Health Cabinet Secretary Susan Nakhumicha pronounced last Wednesday that the Treasury had released Sh3 billion to hospitals, money that is yet to be received.

Additionally, the government is yet to release Sh4.4 billion capitation to the hospitals.

Efforts to get response from the NHIF management on the crisis were futile.

Those seeking treatment in some counties like Kajiado, Narok, Kitengela, Nyamira and parts of Nakuru have been forced to pay for outpatient services because the hospitals are yet to receive their October to December capitation.

Capitation is money paid back to NHIF accredited hospitals for outpatient services.

"There is real crisis, but the government is downplaying it. Businesses are closing up and people losing jobs. It is not a favour paying for services rendered,” said the source.

“The crisis we are in is liquidity. Government owes NHIF money and Kenyans are not paying. We therefore do not have enough money to reimburse hospitals.”The situation is made worse by the dilemma on the transition of NHIF to SHA, who board, chaired by Dr Timothy Olweny, is already in office.

The new authority establishes the Primary Health Fund, Emergency, Chronic and Critical Illness Fund, and the Social Health Insurance Fund.The Social Health Insurance Act, 2023, provides for the formation of SHA, which will repeal the National Health Insurance Fund Act, 1998.However, last month, the court issued an injunction stopping the implementation of the Primary Healthcare Act, Social Health Insurance Act and Emergency, Chronic and Critical Illness Fund.The case, filed at the High Court by Joseph Enock Aura, argues that it is illegal for the government to deny Kenyans services if one was not a member of the medical kitty.

“The courts stopped anything to do with the Social Health Insurance Act from going on until the issues before it are determined. The authority will only be operationalised when courts allow,” said a senior official at the Ministry of Health.President William Ruto had banked on the laws to push Kenya Kwanza’s agenda of improving healthcare services. The laws were also to speed up the implementation of the much hyped Universal Health Coverage.

Presidential health advisor, Dr Thuranira Kaugiria, said there is nothing the government can do until the case is over.

“We are in a limbo. There is nothing that can be done. We are in a crisis, and until the court solves the matter, we cannot move," he said.

Kaugiria, however, restrained himself from sharing more information to avoid being in contempt of court. But is optimistic that the country shall implement UHC to guarantee quality healthcare to all.

The transition from NHIF, a State Parastatal established in 1966, to SHA was to take a maximum of 12 months.The core mandate of the fund has been to provide affordable, accessible and sustainable medical cover to all.

According to the regulations, salaried employees will pay 2.75 per cent of gross salary to the kitty, while non-salaried Kenyans will pay 2.75 per cent of their earnings.Under the regulations, there is no maximum capping on the amount to be paid to the kitty, but the least amount is Sh300.

According to James Kamau, a health economist, the laws were hurriedly passed and enacted without proper understanding on implementation.“Social Health Insurance Act looks very good on paper, but we do not know what the benefits will be because we do not have a benefit package,” said Kamau.A regulation team appointed by Nakhumicha was to come up with a package, which Kamau says has not been made public.He said no benefit analysis was done to show how the new scheme would improve NHIF for best provision of care to beneficiaries.“We are told we shall a maximum of Sh300 to Social Health Insurance Fund, but what shall we benefit and what shall be covered? What shall we be offered with the deduction?” said Kamau.The insurance scheme, according to the expert, has worked well for civil servants, who have a comprehensive cover at Sh1,700.According to Kamau, NHIF had gained confidence among Kenyans, who are now in limbo with the current changes."Proper enactment and implementation of Social Health Insurance Act, the changes should have been gradual," said Kamau.Prof XN Iraki, an economist at the University of Nairobi, said the government is likely to go back to the drawing board and come up with new regulations or law to ensure the programme is implemented. “Kenyans have become so cautious. Whatever the President implements, they will ask whether the law is being followed or not,” he said.“I do not think they will abandon it because it is a major project for Kenya Kwanza. It is one of the flagship project."