Amended NHIF Act key to universal health coverage

Mutahi Kagwe

The National Health Insurance Fund (NHIF) Amendment Bill 2021 passed by the National Assembly recently is a timely intervention.

The Bill, which is now awaiting Presidential assent to become law, provides the necessary legal framework for the attainment of Universal Health Coverage (UHC). 

The National Assembly passed the Bill on December 21 without any changes to the amendments made by the Senate earlier. I commend the two Houses of Parliament for putting the health of Kenyans first.

Accelerating the attainment of UHC is one of the best gifts the legislators could have given their electorate coming at a time when the world is battling Covid-19. 

The NHIF Amendment Bill is a win for all. Those who were previously not covered will now be covered, healthcare providers will now find it easier to realise their mark ups and NHIF will be able to offer an expanded package worthy of a 21st century health insurance fund.

The bill makes it mandatory for all Kenyans aged above 18 to have NHIF membership.

Currently, many people working in the informal sector have not enrolled due to its voluntary nature despite having the ability to pay the NHIF premiums.

NHIF currently covers over 31 million Kenyans. However, the number of people actively contributing stands low at about 40 per cent of the registered members. 

With more contributors, it will now be easier for NHIF to create a sufficient financial base to provide health cover to all Kenyans.

The higher the number of members, the less a benefit package will cost due to economies of scale. 

Universal health coverage will make fundraisers to cater for hospital bills a thing of the past. At the moment, it is common to see even Kenyans deemed to be well-off organising a fundraiser whenever a family member falls sick.   

Better still, the amended law prevents NHIF from withdrawing the benefits of a person undergoing treatment for a chronic illness, a welcome move considering the increasing number of Kenyans suffering non-communicable diseases.

Under the amended law, the NHIF board will carry out a review of applicable tariffs payable out of the fund to contracted healthcare providers every two years. 

This will enable the insurer to periodically increase its funding pool to match the rise in treatment costs. NHIF last reviewed its rates in 2015. 

The biennial review will also enable the Fund to seal loopholes that dishonest health service providers have been using to enrich themselves at the expense of Kenyans. 

NHIF has been grappling with the rise in claims paid and an increase in impersonation cases with claims jumping from Sh19.7 billion in financial year 2015/2016 to Sh54.6 billion in financial year 2020/2021.

While it is important to punish and deter fraudsters, it is equally important not to be seen as being too punitive as this reduces the willingness of the public to report fraudulent activities. 

Hence, the decision by Senate to reduce the penalty for insurance fraud from Sh1 million to Sh100,000 or a six-month jail term will encourage more Kenyans to report on fraudsters. 

The amended law has something for employers too. It exempts employers from paying a matching contribution for their employees if the employer has procured a private health insurance cover.

Overall, NHIF will become more sustainable, and more Kenyans will benefit from health insurance cover. 

In 2018, Kenya began a journey to have Universal Health Coverage (UHC) in place by the year 2022.

This is to be achieved under the Big Four agenda championed by none other than President Uhuru Kenyatta. 

Through UHC, Kenya aims to ensure that all citizens can afford  quality promotive, preventive, curative, rehabilitative and palliative health care services. 

The journey started with UHC pilot projects in four counties namely Isiolo, Nyeri, Machakos and Kisumu.

The pilot ran for one year from December 2018 to December 2019. Lessons from the pilot counties will inform how we roll out UHC in the other counties. 

With an NHIF-backed healthcare programme, the country now stands a good chance to finally attain UHC by 2022 as envisaged under the Big Four agenda. It repositions NHIF as a suitable vehicle towards attainment of UHC. — The writer is the Cabinet Secretary for Health