Reform NHIF to boost healthcare services

Wednesday June 13 2018

There is a plan to make amendments to the NHIF Act

The front entrance of the NHIF building in Nairobi. FILE PHOTO | NATION MEDIA GROUP 

By AMIT N THAKKER
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President Uhuru Kenyatta’s pledge to deliver universal health coverage (UHC) by 2022 is a tough act to pull off.

While he should be hailed for attempting to hit the target eight years ahead of the global goal of 2030, Kenyans have pointed questions about how to get there that fast.

A key element to UHC is affordability. Kenyans are inundated with requests to contribute to one medical harambee or the other.

Kenyans must access the health services that they need without auctioning their assets or begging.

The government’s target of 100 per cent UHC in five years for all households by enrolling 13 million Kenyans and their beneficiaries in the National Hospital Insurance Fund (NHIF) is ambitious. It should first rebuild the NHIF.

However, we must not let this motivation compromise quality. It is too risky to leave the health of all Kenyans in the hands of the premier national health financing scheme.

FACE DANGER

We face the danger of erratically increasing payroll taxes and contributions with little attention to the availability of basic primary healthcare and specialist health services thanks to a fragmented and unresponsive health system.

First, we must shake up the weak NHIF accountability and governance structures, which hinder the success of a seamless rollout of UHC.

We must tackle all the challenges to proper implementation of the coverage. These include systemic delays in reimbursing health providers, false claims from some providers and poor quality of care in some facilities.

The public trust in the NHIF need to be urgently restored through a well-designed strategy to increase awareness on the services covered.

From the financial data available, it’s quite clear that almost half of the NHIF funds are inappropriately used.

MEDICAL CLAIMS

For example, in 2012, the agency collected Sh9.5 billion and paid out Sh5.9 billion in medical claims (62 per cent pay out rate) while in 2016 it paid out Sh10.2 billion in claims from an annual receipt of Sh28.5 billion (36 per cent). Where is the money going, if it’s not to the health of Kenyans?

Too much attention is being given to the ‘rich’ through the NHIF ‘Supa Cover’ with benefits such as medical evacuations, referrals to other countries like India for high-level cancer treatment. This, while there is a huge population in Kenya that cannot access basic outpatient treatment in the counties.

What are our priorities? The NHIF should look into enrolling the poor first before enhancing benefits for the wealthy.

But even with these reforms, the NHIF will not meet the demands for provision of health insurance for all single-handedly. We need to confront the reality of the multiple players in the health insurance and provision playing field.

HEALTH FINANCIAL SCHEMES

Kenya needs an appropriate mix of private and public health financial schemes that consider all approaches with the lowest-possible costs that fairly distribute the financing burden and ensure equity of access to healthcare services.

As the first phase for UHC, we need to build multiple suitable, innovative, cost-effective medical plans — including county government ones — that, in turn, could be re-insured by the NHIF. This kind of competition will drive the NHIF towards greater accountability and quality.

Further, we need a law to oversee the management of the schemes, to protect consumers even as it promotes affordable, quality medical covers.

Finally, a Health Benefits Regulatory Authority would play the subtle role of overseeing registration and licensing of all financing plans as defined by the law.

That would ensure all players are on the same page for the benefit of every Kenyan.

Dr Thakker is the chairman of the Kenya Healthcare Federation. [email protected] Twitter: @docthakker