The National Hospital Insurance Fund (NHIF) will cut down some services offered under its cover.
The services include overseas treatment for special surgeries, rehabilitation for drugs and substance abuse, emergency road evacuation, and imaging services such as X-RAYS, CT scans, and MRI.
NHIF Chief Executive Officer Peter Kamunyo stated that patients will now be required to exhaust other sources of income before using NHIF to pay for the mentioned services.
“Once the patients exhaust their private cover while seeking treatment for those packages, we will pay the remainder of the fees,” Kamunyu reiterated.
He further explained that paying for the special service would make the current model unsustainable.
According to the Health Financing Reforms Expert Panel Report, the national health fund registered loss when catering for specialized surgery and major surgery.
The average costs per claim range between Ksh263,000 and Ksh86,592 respectively.
In 2018/2019, NHIF paid claims worth Ksh22 billion to private hospitals, Ksh8 billion to mission facilities, and Ksh7 billion to public hospitals.
In the same period, it spent Ksh17.7 billion for specialized treatment including flying patients abroad.
The NHIF boss stated that although the company covers the majority of the country’s population, the maximum contribution stands at Ksh1700 and the average contribution is Ksh500 per person.
“Employees contribute through statutory deductions but half of them pay less than Ksh500, which means half of them pay the same as those in informal sectors,” NHIF CEO remarked.
NHIF raised concern over the high number of Kenyans defaulting on their monthly subscription. Out of 10million subscribers, only 5million duly pay for their remittance with most only paying for the fund when they need it.