How to beat escalating medical bills

Mr Abdul Mirimo never imagined that he could be admitted to hospital. So he did not see the need for medical insurance.

He used to medical cover, but since neither he nor his family fell ill, he thought it was a waste of money to maintain it and cancelled it.

However, three years ago, the unexpected happened. He suffered a stroke that paralysed him from the waist down.

He had to spend time in hospital and endure a year of medication and physiotherapy.

“I don’t remember how much money I spent,” he says, “but it was a lot,” he adds, saying that he is lucky to have friends and family who stepped in to help.

Mr Mirimo is not alone. Millions of Kenyans across the country mirror his sentiments. Out of every 10 Kenyans, only one has medical insurance.

“With a population of nearly 40 million people, it is unacceptable that just about four million have insured their health,” the National Health Insurance Fund boss, Mr Richard Kerich, says.

“The NHIF database has about 2.1 million members in the formal sector and 680,000 in the informal sector.”

With 23 medical insurance providers in the country, many people, especially the youth, still shy away from them, not because they cannot afford the premiums or for lack of information, or that they are not educated; they are simply not interested, say experts.

“If you are educated and you don’t have a health insurance policy, I blame it on you because you are no better than an illiterate person,” says Mr Jagi Gakunju, the chief executive officer of AAR.

“The first thing you should invest in is your health because life is full of surprises and it is better to be prepared.”

For 20 per cent of Kenyans living below the poverty line, some of whom live far from any social amenities and information centres, health insurance has not been a priority. They contend with government health centres that offer cheaper services.

Even so, some medical facilities insist on money first before a patient is attended to.

If the patient fails to produce the money, he is turned away. This attitude has led to the perception that healthcare is expensive and only accessible to the few who can afford it.

The result is overcrowding in government hospitals and dispensaries, straining the already overstretched facilities. Sometimes patients return home without seeing the doctor.

“Unlike popular belief, medical health insurance is not a preserve of a privileged class of Kenyans,” says Mr Gakunju. “Anyone who wants to can get insured and we can considerably increase the subscription if the National Healthcare Financing Strategy is implemented, as well as a social welfare option to cater for the vulnerable members of our society, especially women and children.”

Kenya has been grappling with an almost dysfunctional health sector for decades.

Brain drain has created an acute shortage of doctors and other qualified personnel.

There is one doctor for every 6,000 patients, sharply contrasting with the recommended World Health Organisation’s one doctor for every 500 patients.

It is not uncommon to find patients sharing beds in government hospitals or to hear sad stories about Kenyans dying as a result of inadequate medical attention.

Medical health insurers insist that reforms embodied in the new Constitution may not see the light of day if urgent and decisive measures are not put in place through the strategy and other proposals to put the sector on the path that would transform healthcare.

The strategy’s objective is to bring together stakeholders who will provide the financial and technical support critical to the development of healthcare in Kenya.

The media too, has been blamed for the low medical insurance subscription.

Healthcare is underreported, says Dr Kerich, which limits the information getting to the public.

A lot of time and resources are wasted investing in strategic plans that are shelved and new ones quickly developed.

“The plans look beautiful on paper, but as long as they remain on paper, we are not going anywhere. The media should whip all the stakeholders and put them on the spot so that all these plans are implemented. Only then will we move forward.”

Among the plans are the National Health Sector Strategic Plan and the Healthcare Financing Strategy, whose debate has been on-going since 2003, but there is little to show for it.

The partners involved, says Dr Kerich, are more interested in propagating their personal agenda, hence the slowdown.

The financing strategy is a footprint on the path towards Vision 2030.

However, Kenyans have generally been known to be wet blankets where a government project is concerned because it either stalls, the people tasked with the responsibility of seeing it through do such a shoddy job that it ends up doing more harm than good, or the project never materialises.

It is, therefore, not surprising that many view Vision 2030 as just that: a vision.

With this in mind, the government is working to prove the doubting Thomases wrong.

To improve the health sector, the ministries of Public Health and Medical Services, with the National Health Sector Fund, have set up more health centres across the country and hired more health personnel to ease the burden of congestion.

The government has also invested heavily in the state-run NHIF, which has been in existence since 1966 and is a mandatory scheme for Kenyan earning Sh1,000 and above.

According to the Association of Kenya Insurers, the medical class of insurance accounts for 14 per cent of gross premiums charged, and the figure grows as more people sign up.

Currently, the gross premium stands at Sh7.4 billion.

However, the industry is not without challenges. This year, medical insurance providers (MIPs) have lost up to Sh528 million in fraudulent claims, compared to last year’s Sh238.5 million.

“Doctor-patient confidentiality prevents us from assessing the genuineness of medical claims and as a result, we are stuck with fictitious bills,” says Mr Tom Gichuhi, executive director of the Association of Kenya Insurers.

For that, MIPs, including NHIF, are upgrading their systems to reduce fraud.

Also, the Insurance Regulatory Authority is working to establish an anti-fraud unit to catch those who try to cheat the system.

Another challenge is lack of uniformity in the premium rates, which gives hospitals the prerogative to recommend expensive medical procedures — sometimes abroad — that the patient does not need.

Getting more Kenyans insured is the biggest challenge that the insurance industry faces.

“Perhaps the government needs to offer tax relief, the way it has done with Housing Finance. Telling people that they will not be taxed on the money they invest in their health could see the numbers rise,” says Mr Gakunju.

Inflation has not spared the healthcare sector and some hospitals such as Kenyatta, Karen, Mater, Gertrude’s, and Aga Khan have had to revise their charges upwards by up to 40 per cent, leaving patients to bear the pain of more expensive treatment.

These changes are likely to affect medical insurance premium rates.

Even as ministries work towards beating the Vision 2030, medical insurance providers feel that a national health social insurance scheme that offers a basic package to every Kenyan, regardless of their income bracket, is crucial.

The informal sector has for a long time been locked out of medical schemes because they are unable to raise the rates required.

NHIF is consulting with Treasury to work out a plan to cover the poor.

Have you invested in your health?