It's time to tell the emperor he may be unclothed

The ongoing circus between the National Hospital Insurance Fund (NHIF) and private hospitals is beginning to take hostages. It may not be the appropriate time for this to be happening but with the highly politically charged environment in this election year, shocking roadside declarations are fast becoming the norm. 

Last week, in response to the private hospitals’ defiance to the proposed NHIF rates, the Cabinet Secretary for Health essentially declared war. He put the private hospitals on notice, threatening to cap private hospital charges. This is a very brave declaration for a boss whose employer pays a platinum premium so that his insurance allows him to be treated in the same private hospitals he is at war with. 

The culture of slamming private hospitals is not new. However, private hospitals continue to mushroom in every corner of this country. The real reason is that the government of Kenya has not yet invested enough in healthcare to meet the demands of its people. The population growth and the disease burden far outpace any investment government can put in its health systems. This is the real reason private healthcare thrives. 

Even in countries with the best actualised universal health coverage (UHC) like Thailand, private healthcare still thrives. There is no one government that has the capacity to meet the needs of all its people.

The reason that is, is because those seeking private healthcare want more than the treatment! They want a better environment to recuperate in, they want a better menu and a personal chef, housekeeping services every hour, a bath tub instead of a bucket and privacy from other patients. Even within the same private facilities, these extraneous services are further fragmented into standard services, all the way to executive. 

It is important for the government officials driving the UHC agenda to understand fully that UHC is not NHIF and that NHIF is not UHC! NHIF is simply one pillar in the delivery of UHC, which is a means of providing for healthcare financing. As healthcare professionals and service providers, we fully support NHIF reforms as a vehicle for financing. We even support mandatory contribution to NHIF by every household, with the consideration that there is a cushion for those who are unable to meet the cost. What we will not tolerate is wastage of the precious resource to corruption and fraud! 

The bone of contention here is when our leadership starts to equate the actual cost of care to the measly token currently paid by NHIF and other out of pocket sources to the hospital. This is where the lie is.

Let us take the Linda Mama programme for instance, where reimbursement to a government facility is Sh6,000 per normal delivery. When we assume that this is the cost of the delivery, we are dead wrong. 

We have not taken into consideration the development costs of the hospital, the wage bill, welfare, insurance, medical equipment, utilities and many other operational costs that are paid for directly by the taxpayer through Treasury to fund hospital budgets.

And if the high cost of living is anything to go by, these costs are only rising. We have watched the cost of fuel rising by over 40 per cent in the last three years. This translates to the increasing cost of electricity, hospital generator and kitchen. At the end of the day, the Sh6,000 pays for the patient’s medication, food, and other consumables only.

All these costs apply to the private sector too, even before adding in the “hotel” service the private hospital accords you. It is this hotel service that specifically attracts all our senior government officials to these facilities, yet they adjudicate over a populace whose budgetary allocation cannot assure them of basic care at the public hospitals.

Private hospitals do not redirect patients from public facilities. Patients make a choice to go there, except in emergencies. This is not to underscore the importance of public-private partnerships (PPP), but it cannot be a partnership where one wants to destroy the other in order to thrive. thankfullyl, we finally laid to rest the myth that NHIF is paying private facilities more.

The bulk of its money is taking care of patients in our level six referral facilities, as it should be! 

All we are saying is, NHIF should pay fairly and uniformly for cost of procedures in all facilities. However, it must remove the “NO CO-PAY” clause from its contracts! If I choose to have a water birth in a Jacuzzi in a private facility, HNIF should pay for the normal delivery and allow me to pay the difference for the Jacuzzi luxury! This right here, ladies and gentlemen, is the bone of contention!

Dr Bosire is an obstetrician/gynaecologist