Pharmaceuticals have been singled out as the leading reason covering health has become a loss-making venture for insurers.
In the ongoing debate on how to tame high hospital charges, especially in private facilities, doctors’ fees have been mentioned as the second leading cause of the exorbitant medical bills.
These fees, compounded with pharmacy charges, are the reason only 1.3 million Kenyans can afford private medical healthcare.
Even so, as revealed by Jubilee Insurance's Elijah Matolo, a large number of Kenyans with private health insurance as a benefit from their employers.
The high doctors’ fees, Dr Matolo said, were accumulated through procedures, consultations, and inpatient and outpatient visits. The rest constituted laboratory and diagnostic services such as X-rays.
Insurance companies have labelled these high doctor fees as unnecessary, considering that about 74 per cent of Kenyans earn less than Sh50,000, which makes purchasing of health insurance policies almost a luxury.
These high fees by the Medical Practitioners and Dentists Board (MPDB) are currently under review with a possibility of bringing them down as one of the ways of making healthcare affordable to majority of Kenyans.
The board on Tuesday held a public gathering to collect proposals that will be submitted to Health Cabinet Secretary Sicily Kariuki tomorrow.
In the session, doctors in the private healthcare facilities were on the spot for fragmenting some of the procedures performed in a bid to make money from patients who are insured.
In instances where a doctor can perform two surgeries from one incision, insurance firms lamented that the claims submitted would have the surgeries billed as separate procedures.
“If we look at the price, for example a caesarean section will cost Sh120,000 as doctors’ fees alone. But that is not inclusive of the anaesthetist's fee, that of the nurse, the equipment, and other bills. We cannot promise healthcare will be affordable, it is clear doctors are not supporting us,” said Jemimah Mbugua from Resolution Health.
On January 3, 2019 Madison General Insurance released a circular indicating that it would only pay prescription claims for generic drugs.
Generic medicines are supposed to have the same efficacy as the branded or original drugs, although at times there are slight variations.