Release cash to private hospitals, NHIF told

NHIF Building

The National Health Insurance Fund (NHIF) building in Nairobi. 

Photo credit: File | Nation Media Group

Private hospitals have called on the national insurer to release delayed payments to enable them to serve their clients.

The money to be remitted by the National Health Insurance Fund (NHIF), according to Kenya Association of Private Hospitals secretary general Timothy Olweny, has mainly accrued from last year.

Dr Olweny told the Sunday Nation that the current situation is unsustainable for most hospitals and the only way to salvage it is to release payments. “Most of the hospitals are in debt and the only way they will continue giving quality healthcare to their clients and NHIF members is that monies have to be released,” he said.

Even then, Dr Olweny maintained that private facilities were not turning away patients with NHIF cards, but added that “we would understand if such is happening as hospitals are under financial pressure.”

“Turning away patients would be an individual hospital decision because they have different contracts with the insurer. If they decide to do that, then we will definitely understand,” he said.

The association will meet with the NHIF management next week over the issue, he added.

“I know the feeling, but from next week, we will give direction to our members depending on the outcome of the meeting.”

Should they fail to reach a deal next week regarding the payment format, Kenyans seeking services in private hospitals using the NHIF card will have to incur out-of-pocket medical expenses and even dig deeper into their pockets .

For years, it’s been a battle between private, public and NHIF on why the private facilities were being reimbursed the highest amount of money. For this reason, the Fund last year came up with new contracts for 2022-24 to lower the cost of healthcare by reducing doctors’ and other fees.

Then chief executive officer Peter Kamunyo said the standardisation of contracts for all facilities was to benefit patients.

He said doctors were blackmailing the Fund and sabotaging the enhanced scheme, adding that about 50 per cent of the facilities had signed the contracts.

The Fund came up with two contracts for comprehensive and non-comprehensive cover. Facilities had the leeway to choose which one works for them.

For the comprehensive cover, a patient walks to a facility, gets attended to and walks out without paying a cent to the healthcare provider, while for the non-comprehensive, facilities charge what they want but the reimbursement is standardised.

The idea was for the government to invest money in public hospitals, where most Kenyans get services. Dr Olweny said hospitals that went for the comprehensive cover contract are suffering as they have to wait for the claims to be paid before they run their facilities.

“If patients come, get services and go without paying a single cent, then they (private hospitals) have to wait for long for the money to be reimbursed, how are they going to operate? Serious discussion must now happen,” he said.