Health crisis looming as NHIF makes new changes affecting private hospitals

The NHIF bill, if signed will see the rates reviewed every 2 years

NHIF Building in Nairobi.

Kenyans seeking medical services at private facilities using National Health Insurance Fund (NHIF) cards may have to seek alternatives beginning February 1.

This comes after a tiff between the national insurer and the Kenya Association of Private Hospitals who say NHIF has reduced the rates significantly, making them incapable of offering quality healthcare.

The Association insists the new rates have been reduced beyond the threshold set by the Kenya Medical Practitioners and Dentists Council (KMPDC).

The changes are contained in a revised contract between NHIF and private hospitals which takes effect from February.

Private and faith-based health service providers initially had a contract which expired in June 2021. NHIF, however, extended the contract's viability to January 31, 2022.

Ag Director of Medical Services (Head Directorate Preventative and Promotive), Dr Andrew Mulwa, has however insisted that the new regulations were arrived at having followed due process.

Health Cabinet Secretary Mutahi Kagwe said medical fraud has been ongoing at the private facilities leading to NHIF paying the private healthcare providers excess cash.

CS Kagwe noted that claims by contracted facilities jumped from Sh19.7 billion in the financial year 2015/2016 to Sh54.6 billion in the financial year 2020/2021.

Private facilities in turn have complained to NHIF over non-payment of claims. The stakeholders are said to be in negotiation before the new rates take effect.

NHIF rates to contracted private facilities could also be reviewed every two years if the NHIF (Amendment) Bill 2021 which was passed by Parliament in December 2021 will be signed by the president into law.

If no deal is reached by the Association and the health insurer, public hospitals could be stretched since a big number of Kenyans seek health services from private and faith-based healthcare providers.

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