Why UHC won't offer free services

The National Hospital Insurance Fund (NHIF) has announced that Universal Health Coverage (UHC) will not offer free services, but instead affordable care to about four million people in the first phase.

This announcement comes at a time when a bill in Parliament requires business owners to match workers’ monthly contributions to NHIF.

“The bill proposes to insert a new Section 15A to make it mandatory for any person who has attained the age of 18 years and is not a beneficiary to register as a member of the fund,” states the memorandum of the Bill.

The national insurer’s CEO Peter Kamunyo said the neediest will have access to affordable healthcare after being identified by county governments. Inpatient care will include medical and surgical services, enhanced maternal and child health services, enhanced HIV, TB and malaria treatment. He added that they will introduce new packages for dialysis and cancer.

“New packages will include rehab services. We are going to a mode called prospective reimbursement,” he said. “Components of health care are expensive. Human resources and other components like infrastructure and medication cost quite a lot and when we provide access someone has to pay,” he said.

Dr Kamunyo said they had already started an overseas package for Sh500,000 for treatment that is not available in the country and meets the criteria for overseas treatment by the Kenya Medical and Dental Practitioners Council and road evacuation services.

Insurance model

He added that the previous model known as input model was not sustainable and that is why some hospitals run out of medication.

“The model we have taken up now is the output model. This output model is more sustainable. This is an insurance model and in the first phase we will support one million households which is about four million poor people,” he said.

The national insurer was previously excluded from handling Sh3.1 billion allocated for the UHC pilot in four counties.

The Treasury sent about Sh2.1 billion or 70 per cent of the funds directly to Kenya Medical Supplies Authority for the purchase of drugs and essential kits for hospitals in Isiolo, Kisumu, Nyeri and Machakos.

The exclusion of the NHIF was arrived at after the four counties expressed misgivings over governance issues at the fund.

During the piloting phase, the UHC package catered for outpatient care such as consultation, mental illness, and emergency healthcare.