New proposals could make NHIF fully State funded

Friday, October 25th, 2019 06:57 | By
Health Cabinet Secretary Sicily Kariuki. PHOTO/FILE

The government will have to dig deeper to finance the health cover for at least 35 million Kenyans not in the National Health Insurance Fund (NHIF) programme, a panel of experts charged with reforming the public insurer has recommended.

In one of its key proposals in a report they handed over to Health Cabinet secretary Sicily Kariuki yesterday, the panel chaired by insurance expert James Wambugu wants the government to mobilise funds through re-prioritising budgetary allocations. This means re-directing funding to primary healthcare and the referral system where majority of Kenyans need the services most.

“We are proposing that the government goes out of its way to refocus funding to health,” he said at a Nairobi hotel yesterday.

Poor remission 

The panel has recommended that the government pays NHIF premiums for poor Kenyans, whose monthly charge of Sh500 they say has not been consistently remitted.

Wambugu said since Universal Healthcare Coverage (UHC) is one of the key priorities for the government, and owing to the fact that health is the number one necessity for economic development, options are limited to focusing on it.

The proposals make the cost-effective scheme a tax-funded programme.

“We are going to use tax funds to help Kenyans who are not formally employed and who are the majority since the formally employed together with public servants form only 25 per cent of NHIF. This means 75 per cent of Kenyans don’t have access,” he said.

However, while receiving the report, the CS was hard-pressed to explain how the government would fund the scheme. 

She said the government is concerned with the Panel’s finding on the potential un-sustainability of the NHIF. 

“The finding poses a key bottleneck to the sustainability of the UHC programme,” she said.

The CS said this calls for expedited mitigating interventions to be undertaken including the determination of the viability of scheme premiums and their entitlements.

“The implementation process shall be expedited, and it is anticipated that Kenyans shall soon enjoy greater efficiency in accessing NHIF services including a strengthened and responsive customer care interface,” she added.

Some of the key reform recommendations the panel proposed include; the need to actuarially determine premiums and benefit package entitlements  in order to facilitate the sustainability of the cover and establishing independent accreditation among others.

Improved service

The Panel also proposed quality assurance mechanism of health service providers that will facilitate improved quality of service. They also called for institutionalising a governance framework that will facilitate citizen engagement and participation in the UHC programme for improved accountability.

“The regulatory framework we have created with NHIF stops offering private and commercial services and sticks to the three schemes proposed,” an excerpt of the report reads in part.

“Those contributing informally are a small group,” Wambugu said. He added that the informal scheme has been running at a claims ratio of about 3 times, meaning that NHIF has been paying almost Sh3 for every shilling collected.

“The government should harness tax resources by getting money where it does not have a big impact and providing it to the important area such as UHC,” he added.  

Wambugu said, however, the money might not be able to fund 100 per cent of the services that have been defined as essential.

“But this will start at the very primary services including taking on board any service that creates catastrophic expenditure such as a person who has cancer,” he said.

The new plan is the work of a panel taskforce of experts established by the CS in February this year to look at ways of reforming NHIF to achieve the UHC agenda.

A key term of reference for the Panel included drawing a practical action plan to transform and reposition the NHIF as a strategic purchaser for the attainment of UHC by 2022.

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