Patients’ agony as hospitals reject broke NHIF cards
The National Health Insurance Fund building in Nairobi. In public hospitals that still accept NHIF cards, services paid for by the insurer are either not available or require patients to visit private facilities for expensive tests.
Poor patients who depend entirely on the national insurer to pay their hospital bills will have to pay cash or stay without treatment after private hospitals said they will ban the use of the card due to non-payment by the agency.
Nearly 80 per cent of Kenyans have no private insurance and depend on the National Health Insurance Fund (NHIF), the backbone of President William Ruto’s Universal health coverage plan.
In public hospitals that still accept NHIF cards as a mode of payment, services paid for by the insurer are either not available or require patients to visit private facilities for expensive tests.
Health Cabinet Secretary Susan Nakhumicha last week said hospitals are owed Sh20 billion by NHIF and had asked the National Treasury to expedite the payment.
Ms Nakhumicha said she was aware that NHIF has been struggling to remain afloat due to the huge amount of money owed to it by the treasury.
Already, all rural private hospitals are on a go slow, pushing for the release of funds to the facilities for the April to June 2023 quarter to continue offering services.
The Rural Private Hospitals Association of Kenya (Rupha) chairman Brian Lishenga in a letter to NHIF chairman Michael Kamau said that they have been forced to take cash from patients after several attempts to engage the NHIF Board failed.
“You know we took an oath to attend to the patients. It is our duty to do this but we can’t operate. Our accounts are empty, and we are unable to pay salaries, and for three months, we have been offering services running to billions but no one is paying us back,” said Mr Lishenga.
Until the matter is resolved, Mr Lishenga said, all the beneficiaries of the NHIF capitated schemes will be required to pay cash to access services.
“These are our patients. The hospital has to continue running and offering services,” he said.
Under the contractual agreement, the fund is supposed to pay health facilities for a beneficiary of the national scheme a capitation of Sh1,000 per beneficiary per annum within the first 30 days of the capitated period.
Some of the hospitals affected are those that have signed a comprehensive cover agreement with the fund, allowing patients to receive treatment without paying a single cent to the healthcare provider.
However, with non-comprehensive cover, facilities charge patients whatever they want, but the reimbursement is standardised across the facilities. They (facilities) were free to choose what worked for them.
The idea was for the State to invest money in public hospitals where, officials argued, a majority of Kenyans seek services.
The Fund has no option but to wait for the treasury to release the money before they settle the hospital's claims.
Violation of contractual provisions
Acting NHIF Chief Executive Officer Samson Kuhora said they have received the reports and complaints that patients were being sent away, which is a violation of the contractual provisions on the side of the hospitals.
He said they have had discussions with the leadership of the various sector of the providers, including Kenya Healthcare Federations representing national referral hospitals, private and mission hospitals in the country and have agreed that payments are a continuous process and all the pending bills will be cleared.
"Their concerns about delay in payment are legit, but we have contractual obligations and payment will be done continuously. We will not pay everything at once, but it will eventually be done,” Dr Kuhora said.
Dr Davji Atella, the secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), said many hospitals suffered because the government was out to frustrate and withdraw funding from the NHIF.
He alleged that both the national and county governments have been diverting over Sh20 billion annually from NHIF to private insurance firms that are making money instead of giving the tenders to the State insurer.
"Civil servants, including police and Parliamentary Service Commission, State officials and all county governments have private insurance, how do you expect NHIF to stand on its own? This whole mess is caused by the government," says Dr Atella.
But for Kenyans, the push and pull is a real, actual pain now.
For three days consecutively, Ms Priscillah Owako has been moving from one hospital to the other in Siaya County, with no luck, as her card has been declined by all four facilities she visited.
“On Wednesday, I was scheduled for my diabetic clinic and there were tests that I was told to do. When I got to my hospital, I was told that they no longer take the card and that I was to either pay cash or wait for the NHIF to fix its problems,” she says.
Public hospitals, she says, accept the card, but she still had to be sent to another private hospital (to conduct some tests) which did not accept the NHIF card.
“I ended up paying Sh5, 500 for the tests and drugs yet I paid subscription till December,” she says.
Ms Owako represents the plight of 80 per cent of Kenyans without private insurance and fully depend on the NHIF card to access services in various hospitals in the country.
One Martin Mutwa has since paid Sh19,000 for his two dialysis sessions done on Thursday and Saturday. On Monday, he used his NHIF card as the hospitals were yet to ban them.
“I had no option because for me to be alive, I can’t skip my session and should this stalemate continue, then we will suffer. They have to settle this as first as possible. I need to go back for another session on Monday and I do not have the money,” he said.
On average, a single dialysis session costs between Sh9,500 and Sh16,000.
But, thanks to the NHIF, patients do not pay a single cent to access the services, unless they exceed the required three sessions per week. NHIF has restricted the sessions to 10 a month, with an extra session requiring pre-authorisation.
