NHIF doubles surgical procedures, raises hospital refunds 12pc

July 2022 BusinessDaily; The National Hospital Insurance Fund (NHIF) has doubled the number of surgical procedures under its patient’s cover, expanded oncology benefits for cancer patients and increased the reimbursement rates for contracted health facilities by 12 percent.

The State-backed insurer will from Friday pay for 549 surgical procedures up from 292 while cancer patients who previously could only get PET scan using NHIF at Aga Khan Hospital will now get the services at Kenyatta University Teaching and Referral Hospital and a Kitui-based hospital.

The changes are part of the new contracts where the NHIF has contracted over 7,600 public, private and faith-based health facilities at standardised reimbursement rates that will however hit the private facilities.

Health CS Mutahi Kagwe said the increased benefits and scope of hospitals are key to Kenya’s efforts of providing affordable and quality healthcare, especially for low-income earners who primarily use NHIF.

NHIF is a critical plank in the government’s roll-out of the Universal Healthcare (UHC) where all membership is compulsory to all Kenyan aged 18 years and above.

“The new contracts accommodate the concerns of Kenyans and accredited hospitals,” Mr Kagwe said on Thursday.

Under the new contracts, the outpatient cover has been adjusted to cover seven basic laboratory tests for the five most common non-communicable diseases.

The State insurer also retained the benefits package for renal dialysis besides an enhanced package for mental health in response to Kenya’s rapidly growing cases of mental illnesses.

Patients will enjoy comprehensive cover at about 80 percent of the contracted health facilities with public and faith-based hospitals accounting for the big chunk.

But the new contracts will hit private health facilities given that the reimbursement rates has been standardised in what Mr Kagwe said is key to assuring sustainability of the NHIF in the face of universal healthcare.

The changes come at a time the government is set to roll out the compulsory NHIF memberships for all Kenyan adults in what will increase the funding pool of the State insurer to foot affordable healthcare for all.

Under the compulsory membership, the least monthly contribution per adult will be Sh500 translating to Sh6, 000 annually.

The changes are in line with the NHIF Amendment Act 2022 that provides the necessary legal framework for the attainment of Universal Health Coverage (UHC).

NHIF has slightly over 31 million members (both principal and dependants) but the number of those actively paying premiums is less than half, hurting the scheme’s ability to foot treatment bills.

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