Private Hospitals up in Arms against the Proposed New NHIF Rates

Kenyan private hospitals have been in a protracted standoff with the National Hospital Insurance Fund (NHIF) whose key mandate is to provide; affordable, accessible, and sustainable medical cover to all. The major issue of contentment is the downward revision of rebate rates that private hospitals consider not feasible. The private hospitals are alarmed by the new rates that do not conform to the costing guidelines provided by the Kenya Dentist and Medical Practitioner’s Board. Furthermore, they have opposed the move as it does not cover the existing costs to afford the said services to patients. Previously, the fee payable by NHIF for dialysis patients was KES. 9,500.00 Per session where the patient was required to undergo a minimum of two sessions per week. This has however been revised to a proposed KES. 6,500.00 Per session; the amount which is way below the rendered services.

According to NHIF the proposed rates are expected to lower the cost of healthcare and increase access for the majority of Kenyans covered by the insurer. It’s important to note that most of the informal sector relies on NHIF to access medical care. Thus, the NHIF board argues that the move is to ensure equity and standardization of the reimbursement of funds.

NHIF deals with private hospitals in a contractual capacity that is renewed every three years. There’s an expectation that a new contract will be signed after the 31st of March 2022 as a product of the ongoing negotiations. Once signed, the new contracts will come into effect on 1st July 2022. This will ensure there is a legislative environment to address issues of benefits package, and strategic purchase of healthcare services to ensure NHIF is sustainable.

The members of the public who are subscribed to NHIF, have expressed their dissatisfaction with the proposed rates that could lead to poor quality health services. The move is likely to alter the patient preference in favor of patients who are paying cash instead of NHIF.

The healthcare workers also cited the issue may lead to patients seeking services elsewhere thus leading to workforce shortages and staff work burnout. Whereas NHIF and private hospitals have temporarily suspended the move, a longer-lasting solution to all sector players would be ideal such that hospitals are paid adequately for services rendered, patients are satisfied with the quality of the services offered and healthcare workers are well catered for to ensure the NHIF scheme is functional.