NHIF doubles surgical procedures and increases hospital reimbursements by 12%


NHIF doubles surgical procedures and increases hospital reimbursements by 12%

The National Hospital Insurance Fund (NHIF) in this photo taken Tuesday, October 26, 2021. PHOTO | DENNIS ONSONGO | NMG

The National Hospital Insurance Fund (NHIF) has doubled the number of surgeries covered by its patients, expanded oncology benefits for cancer patients and increased reimbursement rates for healthcare facilities by 12%. contract.

The state-backed insurer will pay from Friday for 549 surgeries up from 292, while cancer patients who previously could only get a PET scan using the NHIF at the Aga Khan Hospital will now receive services Kenyatta University Teaching and Referral Hospital and a Kitui-based hospital. .

The changes are part of new contracts where the NHIF has contracted more than 7,600 public, private and faith-based health facilities at standardized reimbursement rates which will however hit private facilities.

Health CS Mutahi Kagwe said the increased benefits and outreach of hospitals are critical to Kenya’s efforts to provide affordable and quality healthcare, especially for low-income people who primarily use NHIF.

The NHIF is a vital part of the government’s rollout of Universal Healthcare (UHC) where membership is compulsory for all Kenyans aged 18 and above.

“The new contracts address the concerns of Kenyans and accredited hospitals,” Kagwe said on Thursday.

Under the new contracts, outpatient coverage has been adjusted to cover seven basic laboratory tests for the five most common non-communicable diseases.

The public insurer has also retained the kidney dialysis benefit package in addition to an improved mental health package in response to the rapid increase in cases of mental illness in Kenya.

Patients will have full coverage in about 80% of contracted health facilities, with public and faith-based hospitals accounting for the bulk.

But the new contracts will affect private health facilities as reimbursement rates have been standardized, which Kagwe says is key to ensuring the sustainability of the NHIF in the face of universal health care.

The changes come at a time when the government is set to roll out mandatory NHIF memberships for all Kenyan adults, which will increase the public insurer’s funding pool to provide affordable healthcare for all.

Under compulsory membership, the minimum monthly contribution per adult will be 500 shillings, or 6,000 shillings per year.

The amendments are in line with the 2022 NHIF Amendment Act, which provides the legal framework necessary to achieve universal health coverage (UHC).

The NHIF has just over 31 million members (both primary and dependents), but the number of those actively contributing is less than half, hurting the scheme’s ability to pay treatment bills .

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