The National Hospital Insurance Fund (NHIF) has warned accredited hospitals that they risk having their contracts cancelled for subjecting patients to unnecessary drug expenses.
Chief Executive Geoffrey Mwangi said some hospitals were billing contributors then denying them drugs.
This has forced NHIF contributors to incur additional costs on drugs.
“There have been reported cases of lack of drugs in some facilities. The same are under investigation and consequences may lead to degazettement,” said Mwangi.
So far, NHIF has contracted over 5,200 hospitals countrywide following the extension of services to health centres and dispensaries. About five years ago, the fund partnered with 2,000 hospitals.
Cases of patients being referred elsewhere to purchase drugs have been on rise, exposing the sick to unnecessary and unexpected costs.
Usually, patients expect that accredited facilities are well-equipped with drugs.
Among the conditions that accredited facilities have to meet are good infrastructure, clinical governance, licence to operate, patient rights, safety and risk management.
“The hospitals are our partners and we engage on matters of quality improvement. In the same breathe, hospitals must comply with the minimum criteria within the set standards in terms of drug supply,” said Mwangi.
According to Abdi Mohamed, the chairman of Kenya Association of Private Hospital, which represents small and medium sized hospitals and clinics, some accredited facilities may be finding it hard to maintain the required standards.
He said some of the officers sent to accredit facilities might not be doing a thorough job or some hospitals could be compromising on standards once accredited.
“Other hospitals satisfy NHIF that they have everything but after accreditation, they fail to maintain the standards that were required. I think NHIF needs to maintain a continuous monitoring and evaluation process,” said Dr Mohamed.
Mohamed said some hospitals might be finding it unsustainable to cover some patients due to the absence of special NHIF cover for chronic ailments.