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Lawmakers have accused State health insurer of collecting billions from the poor to fly the rich abroad for specialised treatment. The poor are then left to struggle with unending fundraisers to meet their medical expenses.
The MPs yesterday also accused the National Hospital Insurance Fund (NHIF) of spending billions to cater for medical expenses of the well-off patients in high-end private hospitals when the poor and elderly were resigned to fate.
Members of the National Assembly Health Committee made the remarks when NHIF acting CEO Nicodemus Odongo appeared before them and tabled documents that revealed how private hospitals continue to pocket billions in claims payments.
The documents revealed that government and mission hospitals, which are generally accessed by a majority of Kenyans of low income, were receiving less than half of what private hospitals get annually.
For instance, in the 2018/2019 financial year, private hospitals received Sh22 billion from the insurer while government and mission received Sh7 billion and Sh8 billion respectively out of its Sh37.7 billion expenditure.
In the same period, NHIF spent 17.7 billion for specialised treatment which included flying some patients abroad for medical attention. The figure was higher than what it spent on inpatient and outpatient treatments that stood at Sh11.8 billion and Sh8 billion respectively.
The committee chaired by Sabina Chege (Murang’a) consequently ordered the insurer to provide list of all patients it has sponsored for treatment abroad and a breakdown of claims by private hospitals.
Committee Vice Chairperson Swarup Mishra (Kesses) claimed private hospitals were colluding with the insurer to swindle contributions by Kenyans through exaggerated claims.
Dr Mishra said that some hospitals collect tens of thousands of shillings after performing minor operations which they declare as major ones.
List of beneficiaries
Ugenya MP David Ochieng said it was becoming apparent that the insurer was using contributions by the poor to cater for the rich.
“Can you tell us that NHIF is using poor people’s money to take the rich for specialised treatment abroad,” posed Ochieng.
“We also need to be told the justification why private hospitals are receiving more money compared to what public hospital get from the insurers unless we are using poor people’s money to have the rich in private hospitals,” he added.
Tongaren MP Eseli Simiyu demanded to know the criteria used to pick those sponsored for specialised treatment and list of all beneficiaries for scrutiny by the committee.
The insurer also came under sharp criticism for registering and handing the elderly with NHIF cards which have not been loaded for them to access healthcare.
The cards by the elderly are just pieces of papers that cannot help them access healthcare.
Odongo admitted that there could be some leakages, before he quickly highlighted some of the measures the insurer had put in place to prevent any form of fraud by private hospitals.
He said expenditure for specialised package had shot up because of high cases of cancer patients seeking treatment using the cover, stating that at least 15,000 people were receiving cancer treatment.
“For cancer, you cannot start treatment and abandon the patient midway,” he said.
He told the MPs that to prevent any fraud by hospitals, the insurer has resorted to pre-authorisation to ensure approval is done after knowing details of medical care sought.
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