Early last month, a cousin who has a recurring cancer detected the lump re-emerging and local physicians advised that he be taken to India, where he was initially operated on.
While admitted at a local hospital, he knew the bills would be taken care of; after all, he was self-employed contributor to the National Hospital Insurance Fund (NHIF) and had an executive comprehensive health cover with a limit of Sh3 million from a leading private insurer.
But while in India, he realised that the private insurance covered up to Sh500,000 for cancer ailments. The only option was to fundraise.
The mitigation he thought he had put in place was, actually, a transparent wall: It did not help.
So, what works for an average Kenyan who isn’t formally employed and doesn’t have a million shillings at his disposal in case of an eventuality?
A desktop research of the three leading private insurers who also offer health insurance reveals something not always given a thought but serious. Their individual health insurance packages — having selected the most executive of them — range from a limit of Sh3 million to Sh4 million.
Cancer is capped at Sh500,000 and one can only benefit after a year of paying premiums. The same for kidney ailments.
But these specifics are never revealed at the point of sale; only the general upper limit.
Does this have to do with why the uptake of health insurance is so low in Kenya? The disappointments, the ‘not-said’ clauses and clarifications?
A normal, average surgical cancer or renal operation costs an upwards of Sh1 million.
Surely, the best health individual cover should at least cover one operation but, no, it can just offset part of the bill.
It is time private insurers were realistic in the packaging and pricing of their schemes. In benefiting, you enrol a lifetime member and others who have testimonials from a single life opening coverage. The end result is more people joining, because it will work for you.
To the government’s Nexus social site shows that NHIF made a net profit of Sh1.5 billion for just three months — July-September 2018. One can make a projection of Sh6 billion to Sh8 billion in one year.
It is also factual to say that NHIF has been a lifesaver, especially for the many unemployed people subscribed to the monthly pay up system.
ROOM FOR IMPROVEMENT
But there is room for improvement: As a public health insurer, NHIF should not be too focused on making profits but just breaking even after subscribers have been compensated. It does not make sense for NHIF to cap surgical cancer and renal ailments at Sh500,000. That is denying someone treatment, yet it declares huge profits.
NHIF should expand their benefit bands to cater for more cancer and renal patients. It can also have a dedicated separate fund that would give a member treatment till recovery, irrespective of the bill.
Most importantly, NHIF should invest its huge profits in long-term schemes.
Radical as it may sound, it should be running the country’s referral hospitals.
If Kenyatta National Hospital were run by NHIF, in the long term, the insurer would spend less on local claims than it does on overseas treatment.
The change of management would result in better services and infrastructure, as well as modern equipment and well-paid, skilled medical personnel.
These would be accessed by contributors at no cost but paid for by non-members.
The Sh10 billion spent by 10,000 Kenyans annually on treatment in India can be avoided if service delivery at Kenyatta National Hospital, for instance, were at par with Indian hospitals.
Private investment in health is good but it should not be at the expense of provision of affordable and universal healthcare.
Mr Abwajo is an economist based in Kisumu. [email protected]