NHIF reforms: State to pay premiums for poor Kenyans

The National Health Insurance Fund (NHIF) will from next year stop collecting the voluntary Sh500 from people in the informal sector.

This decision was arrived at after a team of experts tasked by the Ministry of Health to look into ways of transforming the fund recommended that the majority of people in the group are struggling to pay their monthly contribution hence defaulting.

While presenting their report to Health Cabinet Secretary Sicily Kariuki, the team noted the government will start paying for the group, citing a high default rate among the group, with only 35 per cent consistently paying their premiums.

MONTHLY CONTRIBUTIONS

“It is very unfortunate that when some of them go to hospitals, they cannot get the much-needed services because they have failed to remit their monthly contributions. They too need to be assisted,” said panel chairman James Wambugu.

He said if the reforms recommended by the government are adopted, the government will cover about 35 million, more so children and other dependants hence the actual premiums paid will be lower.

Mr Wambugu clarified that with the high default rate in the scheme, NHIF spends three times more money paying for treatment of Kenyans in that scheme, compared to their contributions.

“This is an expense on the government. Instead, we have proposed that the government allocates funds to cover the uninsured Kenyans. This is going to reduce the spending since the government is able to plan,” Mr Wambugu said.

VOLUNTARY PAYMENT

He clarified that even as the government scraps the voluntary payment, normal mandatory contributions from civil servants and those in regular employment will continue.

“It is only the people in the informal sector who contribute Sh500 monthly and poor Kenyans who are not insured that will benefit from the scheme. For those employed, nothing changes,” he added.

Mr Wambugu said so long as one is a Kenyan, they are eligible for the standard scheme to get the basic essential medical services in accredited hospitals of their choice.

“All they need is to produce their identification card then they will be able to be identified by the system. They will get all the services except the complicated services,” he says.

REFORMS

The reforms also seek to transform NHIF from a commercial scheme to a social health insurance scheme to cater for the health needs of Kenyans.
It also suggests that an independent organ should take over grading and accreditation of hospitals and service providers, in efforts aimed at delivering Universal Health Coverage (UHC) by 2022.

Ms Kariuki noted the report also proposes the Insurance Regulatory Authority (IRA) should stop regulating the NHIF. The experts collected views from over 40 organisations over 45 days.

Ms Kariuki constituted the panel on February 26 following President Uhuru Kenyatta’s directive to reform NHIF and the Kenya Medical Supplies Authority.