Why NHIF members should worry
The government and private hospitals are in a standoff after the latter threatened to turn away patients under the national medical insurance starting Tuesday.
According to the Kenya Association of Private Hospitals (KPHA), the National Health Insurance Fund (NHIF) proposes to drastically slash doctors’ fees in the new contracts, which will have a significant impact on patient care, and which is not viable to their institutions.
The hospitals have, therefore, said patients with NHIF cards will be locked out of service until further notice.
Dr Timothy Olweny, secretary general, KPHA, said the new contracts were hurriedly executed without adequate time for perusal, and implementation would be counterproductive.
He said in the new contract for the year 2022 to 2024 which they have not had a chance to look at, the input of private hospitals was not sought, save for a few providers and the contents of the contracts currently being circulated for execution will not work for them.
The documents seen by the Nation, dictate what the doctors are supposed to charge, the cost of the procedures and what other specialists should be paid.
“The charges are even lower than what was proposed by the Kenya Medical Practitioners and Dentists Council in 2016. We are not going to sign the contract until they are reviewed,” Dr Olweny said.
New dialysis fees
For instance, in the new contract, for appendectomy (a surgical operation to remove the appendix) the combined rate proposed by the NHIF suggests that doctors’ fees and hospital charges should not exceed Sh40,000. However, under KMPDC guidelines, doctors’ fees range between Sh60,000 and Sh120,000, while anaesthetists are allocated Sh20,000.
For haemorrhoid surgery (to remove swollen blood vessels inside or around the anus and rectum) KMPDC guidelines for doctors’ fees is from Sh70,000 to Sh150,000; but for NHIF, the services should not exceed Sh24,000.
For removal of tonsils, the insurer says the fees should not exceed Sh32,000, however, private hospital doctors have been charging between Sh60,000 and Sh120,000.
The 2016 KMPDC fee guidelines are overdue for review.
The hospitals have also refused to adopt the new dialysis fees reviewed in the new contract -- Sh6,500, down from Sh9,500.
The NHIF has indicated in the new contract that it will increase the frequency of dialysis sessions from the current two to three a week to be in line with international standards, but has reduced the reimbursement by Sh3,000, which means patients will have to pay the difference.
“NHIF is not only unfair to patients, but also to hospitals, which spend a lot of their resources in offering the specialised care. Many patients will suffer since the majority of the dialysis centres are in the private sector. The private hospitals have 142 dialysis centres with only 54 in public hospitals and 17 in faith-based facilities,” said Dr Olweny.
Healthcare providers
He said the medical benefit packages were developed without proper stakeholders’ involvement and have the impact of lowering the quality of healthcare services to the public if implemented as proposed.
“A case in point is the cutting of the number of sessions that NHIF will pay for dialysis of renal patients without due consideration of the outcome of the treatment for these vulnerable groups. Stakeholders to be involved in formulating sound medical benefits package that will guarantee affordable quality health service delivery,” he said.
Even before the hospitals arrived at the decision to bar NHIF card holders, the key stakeholders in the healthcare service delivery and hospital associations made concerted efforts to engage the NHIF management to get an insight into the changes proposed in the contracts for the 2022-2024 period as is customary, to no avail.
“To date, we have not been formally provided with any draft contract documents that would form the basis of meaningful stakeholder engagement or public participation as required by law. It is against this backdrop that we are gravely concerned by reports that the NHIF has unilaterally proceeded to issue contracts to some of our member facilities for summary execution, in certain instances within a 24-hour period,” he said.
He said the process of developing the contracts was unprocedural, lacking the meaningful engagement of healthcare providers, and with only four days left to the expiry of the extended contract, Kenyans would be on their own.
Dr Olweny said that the initial contract, for three years, expired in June last year and was to be renewed in July until June 2024.
However, all they have been getting are one-month extension contracts from the fund.
Quality health care
Before a contract is signed, stakeholders, including hospitals have to receive the draft for perusal and review it, then give the final position before it is adopted. This should be done before the expiry of the contract.
“When the contract was about to expire, I requested the review of the new contract but we were told that the board of management at the fund had to go through the draft before it was shared,” Dr Olweny said.
The draft was never shared and all they had from the NHIF chief executive officer, Dr Peter Kamunyo, was an extension of the contract until January 31, 2022.
“The current re-contracting exercise is expansive in breadth and complexity and the fund is committed to ensuring that health care providers sign a contract that reflects the mutual interest of offering access to quality health care to Kenyans,” Dr Kamunyo said.
Dr Kamunyo recommends that the contracting process be halted with immediate effect until their associations formally receive copies of the draft contracts as currently prepared, peruse the contents, engage members, get legal advice as required, engage NHIF as required and have their concerns addressed.
“Only after inclusion of our concerns will we communicate an informed advisory opinion to our member facilities,” he said.
The NHIF management was yet to respond to the Nation’s questions by the time of going to press. BY DAILY NATION
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