Medics and NHIF in tussle over new contracts with providers

The National Hospital Insurance Fund (NHIF) has found itself at loggerheads with healthcare providers in the country.

The doctors union and other medical associations have come forward to protest the service provider contracts that were recently released by NHIF to healthcare providers. According to the medics, the process of developing the contract was not inclusive and transparent, something that the NHIF disputes.

In response, NHIF Chief Executive Officer Dr Peter Kamunyo defended the contract process saying all the stakeholders were involved in more than a year’s process.

“The process of the new contract has been ongoing for more than a year with extensive consultation with stakeholders regarding the benefits package,” Kamunyo said.

The section of medics and healthcare providers claim the proposed medical benefits package will lower quality of healthcare services if implemented.

Kamunyo said NHIF has achieved standardisation of all healthcare levels and “we have done risk adjustment for hospitals dealing with noncommunicable diseases and capitation rate has gone up,” he said.

On December 17, NHIF issued contracts for both minor and major surgical services to its members for the period 2022-2024.

He said the package has enhanced second-line treatment for cancer patients and on dialysis increased number of sessions to three sessions per week and contained the cost.

The renewed offer was issued with a proposed medical fee for 411 different types of surgeries ranging from heart, ear, nose, and throat, neurosurgery, gynecological, orthopedic, pediatric and urological surgeries.

The national insurer in the recent past has faced a growing national outcry over dialysis cover with criticism that its proposal will see hundreds lose coverage.

In its proposal, NHIF had increased the number of dialysis sessions from the current two per week to three, retaining the reimbursement of Sh19,000 per week, each session costing Sh6,500.

Patients and nephrologists cried foul over the move that fearing that patients may need to pay an additional out of pocket fee to meet the costs.

Yesterday medics cited possible gaps in the proposed medical package which may derail gains made in healthcare service delivery.

“This injures the health of the patients with chronic illnesses as it will greatly affect quality of healthcare and increase cost of treatment,” Dr Were Onyino, President Kenya Medical Association said.

Onyino explained the surgical package as proposed covers for less than 30 per cent of the need seen for surgery across the health facilities and further limited the surgeries to a select few facilities which hamper access to surgical services.

The medic recommended the current super cover benefits be of a minimum benefit package and additions to be discussed with stakeholders for adoption.

In a joint communique the Kenya Association of Private Hospitals (KAPH), Rural Private Hospital Association of Kenya (RUPHA), Kenya Medical Association (KMA) Kenya Dental Association (KDA) demanded an immediate halt to the process “until the associations “formally” receive copies of the draft contacts, revise and ensure all concerns are addressed”.

The health stakeholders have accused NHIF management of having not proving any draft contract documents that would form the basis of a meaningful engagement or public participation.

“Our input was not sought save for a few providers, we are not privy to the contents of the contacts being circulated for execution,” read the statement in part.

On the reimbursement rates for healthcare services, the medics protested that the proposed rates are insufficient and not enough to cover the cost of service delivery.

Adding that insufficient reimbursement rates will lead to rationing of services and an increase in out-of-pocket expenditure.

They stated the proposed reimbursements have been cut by 50 per cent of the current rates that have been in place for the last three years.

They recommended the proposed reimbursement rates factor in the real cost and cost drivers of healthcare.

The Kenya Dental Association issued a hard stance demanding wide consultation which it claimed the contract have omitted oral health benefits.

They advised all their members against signing any contracts issued by NHIF branch offices until such a time the associations shall advise to the contrary.

Through the consultation, Kamunyo said a raft of reforms were recommended to ensure that NHIF moves from a passive purchaser of health care services to a strategic purchaser.

On maternal health, Kamunyo noted that the benefits package for maternal child health has not changed in any way.