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NHIF to unveil new pacts with private centres

Thursday, June 30th, 2022 10:00 | By
NHIF chief executive Peter Kamunyo during the signing of a pact with Johnson & Johnson Kenya. Also at the forum was Asgar Rangagoonwawala of Janssen Pharmaceutical Companies of Johnson & Johnson. PHOTO/ William Oeri

National Hospital Insurance Fund (NHIF) has brokered a deal with private hospitals on proposed new fees that were suspended early this year following protests by health institutions.

The two entities are now scheduled to ink a deal today, after which NHIF members will start benefiting tomorrow, coinciding with the first day of the government’s financial year.

When the deal was suspended, NHIF cardholders were denied services at private hospitals. This should ideally end from tomorrow. Only civil servants were allowed to use NHIF cards to access medical services at private hospitals during the stand-off.

Kenya Association of Private Hospitals (KAPH) chairman and co-founder Abdi Mohamed told People Daily earlier this month that the disagreement with private hospitals will be water under the bridge.

“The outstanding issues have been sorted out. We will sign the new contracts. We are just waiting for a few other soft concerns, such as the length of the contracts and what they entail,” he said.

Once the deal is signed, all NHIF members will be reinstated into the system to start receiving services using their cards.  This will be a huge relief to millions of patients and their families who have been paying for health services out of pocket.

Early in the year, Dr Mohamed led a protest against the terms of engagement with NHIF on grounds that they were not favouring private hospitals. This led them to boycott the fund.

During the last review, which ended in June 2021, NHIF reduced the amount of money for claims lodged by private hospitals on the basis that they were overpriced.

In his media interview on Tuesday night, Azimio-One Kenya presidential candidate Raila Odinga revisited the issue of high cost of treatment in private hospitals, accusing some of charging more for accommodation than five-star hotels. He said this had left many families destitute.

After expiry of the earlier contract last June, the Fund and private hospitals extended their arrangement by another seven months, which ended on January 31.

Previously, NHIF would pay Sh9,500 for each dialysis session. Dialysis patients require at least two sessions a week.

But NHIF later lowered the fee to Sh6,500 per session, leading to protests from private hospitals. On its part, NHIF said the fee was sufficient to cover hospital costs and profit margins for their services.

The Fund had also set the maximum amount for reimbursement for caesarean section operations at Sh20,000, yet private hospitals charge about Sh150,000.

According to KAPH, an obstetrician charges Sh96,000 or a maximum of Sh180,000; anaesthetists charge a minimum of Sh30,000, or a maximum of 60,000, yet the NHIF was setting a maximum of Sh20,000 for each of these surgeries.

Although NHIF maintained that the revised rates could allow more people to benefit from its services, KAPH insisted that private hospitals would lose at least Sh6,000 per patient per week.

Neither NHIF nor KAPH was willing to disclose the new fee charges agreed on.

Earlier this month, NHIF chief executive officer Peter Kamunyo said the two sides had reached a consensus to continue delivering services to patients at a standardised cost. He thanked private health facilities for their change of heart.

“From July 1, we will launch our contracts with private hospitals. We shall have both comprehensive and non-comprehensive contracts,” he said at Kenyatta University Teaching, Referral and Research University.

During the event, NHIF also signed a memorandum of understanding with Roche Kenya Ltd to provide Herceptin drug for breast cancer patients.

The partnership will lower the cost of the drug to Sh15,000, down from Sh30,000.

Yesterday, the Fund signed another contract with Johnson and Johnson, which will offer treatment options for patients with prostate cancer (see sidebar).

If the new terms of engagement will hold, NHIF members will access health services from private hospitals without paying a shilling.

“This is why such partnerships are very important,” Kamunyo  said in an earlier interview.

Unveil new contracts

In January, Health CS Mutahi Kagwe gave a commitment that new contracts would be signed. The ministry, together with NHIF, have called a press conference today during which they are expected to unveil the new contracts.

“The contentious issues have been ironed out,” Kamunyo said earlier in the month. “We are proud of the work achieved in partnership with the Ministry of Health and NHIF in overcoming multiple access barriers to the standard of care treatment for a number of critical disease conditions, including breast cancer”.

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