KENYA: Cover enough to treat patients, says NHIF

October 2015 DailyNation; The National Health Insurance Fund has refuted private hospitals claim that the Sh1,200 capitation allocated for outpatient services per member is inadequate and unsustainable.

NHIF rolled out the new outpatient health cover on July 1 this year, after years of only offering in-patient cover.

Ever since, private hospitals listed by the government to offer treatment to NHIF contributors have been clamouring for the increase of the capitation per patient to between Sh6,000 and Sh10,000.


“From an economic point of view, every player would want to push for more resources, so health facilities were trying to push for more resources but after sitting and talking them through how we worked out the figures they are able to understand now,” said NHIF investments and finance director Mr Geoffrey Mwangi at an editor’s media briefing in Nairobi Wednesday.

Private hospitals which constitute an estimated 50 per cent of the country’s health care infrastructure have been turning away patients seeking outpatient treatment under the State cover arguing the Sh1,200 capitation per member is unrealistic and unworkable for a whole year.

NHIF strategy and planning director Mr Nicodemus Odongo, however, said the figures had been benchmarked from global models of health insurance.

“Currently a number of hospitals which have done that mathematics have now rushed down to us to register. We have 900 hospitals on board willing to offer the cover,” said Mr Odongo.


Earlier, NHIF chief executive Mr Simon Kirgotty said the private hospitals demands are unsustainable and the fund would have to close shop if it reviewed the caps upwards.

Private hospitals led by Dr John Nyauma, the chairman of the Kenya Association of Private Hospitals (Kaph), a national association of medium and small private hospitals in Kenya, have in the past claimed that an independent study said to have been commissioned by the government and conducted by fund managers, Alexander Forbes, corroborated their claims that the current caps are not sufficient for effective healthcare for contributors.

They have insisted they would only consider implementing the plan if NHIF reviews the figure to at least Sh6,000 with the ideal being Sh20,000 in line with the said study.


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