Teachers encounter problems in roll out of new health scheme
Education PS Belio Kipsang (left), CS Fred Matiang'i and TSC CEO Nancy Macharia chat at Shimo La Tewa High School before the announcement of the 2016 KCSE results on December 29, 2016. Teachers are complaining about their new medical cover. PHOTO | LABAN WALLOGA | NATION MEDIA GROUP
What you need to know:
- If the patient is to go through five processes at the hospital, he must send the SMS five times, with the cost being borne by the teacher.
- Teachers interviewed said they found the process cumbersome and time-wasting. Some complained of missing lessons.
Teachers are facing difficulties getting services at hospitals after the introduction of a new access system.
This is the latest controversy in the Sh15.3 billion medical insurance scheme.
The system is being run by Bliss GVS, a company that is barely four years old.
It is now in charge of the country’s second largest medical scheme.
The lucrative tender to provide insurance cover for teachers was won by AoN Kenya, which initially contracted a firm known as Smart Applications to run its access system.
In the new system, a patient sends a text message to AoN. The firm replies with a code authorising payment.
Once one gets services, he or she sends the code to the company.
If the patient is to go through five processes at the hospital, he must send the SMS five times, with the cost being borne by the teacher.
It is even more complicated if the patient is the teacher’s dependant.
He has to call the main beneficiary to send the text message in order to get the code.
ACCESS DELAYED
Teachers interviewed said they found the process cumbersome and time-wasting. Some complained of missing lessons.
In a limited number of hospitals, administrators of the new system have attempted to introduce biometric registration and identification with little or no success.
In the old system, a teacher only needed a smart card to access services.
In October last year, teachers began complaining that they were being made to use alternative methods of identification at hospitals.
“I was discharged in the morning but I have been waiting for more than six hours to get a response from the medical scheme administrator before the hospital allows me to leave,” Mr Joseph Kamau complained at Coptic Hospital, Nairobi.
Those interviewed said they were not notified of changes in the system.
“I took my child to hospital but was shocked to learn that I could not use the card,” said Mr Abel Ombati.
Some teachers also say their dependants’ names are missing from the system.
Hospitals confirmed that the system took between two to four hours to authorise payment.
Among hospitals that have raised concern are Coptic, Mariakani Cottage, Eldoret and Radiant.
AVOIDING BLAME
Doctors and nurses say they now have to brave long queues as a result of delays in getting authorisation from the insurance broker.
Some hospitals are turning teachers away.
Interestingly, Bliss GVS is linked to Clinix Healthcare Ltd, the company investigated and suspended in 2012 for irregular practices in the civil servants’ and security forces medical cover scheme.
A parliamentary committee found that the National Hospital Insurance Fund paid phantom hospitals Sh120.5 million, with Clinix getting Sh92.4 million.
Contacted, Kenya National Union of Teachers Secretary-General Wilson Sossion was non-committal.
“Find out from the Teachers Service Commission and AoN,” he said.
TSC also distanced itself from the complaints, saying AoN was best placed to handle the complaints.
“If the new system is working there is no reason to worry,” said Dr Njoki Fernandes, who handles the teachers’ medical scheme at AoN.
However, she failed to respond to probing for more information on the name of the new access system and how much time it takes teachers to access services.
