KENYA: Cotu threatens to sue NHIF in outpatient cover dispute

October 2015 DailyNation; The Central Organisation of Trade Unions (Cotu) is locked in a fresh row with the National Hospital Insurance Fund (NHIF) over the public health insurer’s preference for private hospitals to State-owned facilities.

Cotu secretary-general Francis Atwoli has threatened to block the higher contributions to the NHIF on the failure of the fund to strike fresh deals with government hospitals to offer outpatient services.

 

The workers’ umbrella union reckons that the NHIF members have been unable to access outpatient services in government hospitals.

 

“We will move to court to stop the contributions as most of these private hospitals are run by individuals out to make money at the expense of workers’ health,” said Mr Atwoli in a letter to NHIF chief executive officer Simon ole Kirgotty dated October 19.

 

“NHIF’s continued delay in securing a deal with government hospitals amid growing concerns from our members who are being turned away from hospitals despite records showing they are up to date with NHIF contributions.”

 

The fund in April increased monthly contributions from Sh320 up to Sh1,700 with the promise of enhanced benefits in premium facilities, including the introduction of outpatient services. But implementation of the enhanced scheme has not been smooth.

 

Contributors are not getting outpatient treatment for chronic diseases like cancer, diabetes and hypertension at private hospitals. Instead, the contributors will only receive basic care for ailments like malaria, pneumonia and typhoid.

 

The exclusion of chronic diseases goes against the government’s promise to include them in the cover at both public and private facilities to justify the new monthly contributions.

 

The second-tier private hospitals, which had initially rejected the State-backed scheme that came into force on July 1, said they had agreed to provide minor care after accepting the NHIF’s Sh1,200 offer as annual capitation per beneficiary.

 

Mr Atwoli wants NHIF to ink deals with all government hospitals that will see the facilities establish wings dedicated to all NHIF card-holders.
“The card holders should be able to walk in and out without any hitch,” he added.

 

NHIF premiums are now tied to gross salaries, capped at a maximum Sh1,700.

 

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