• Health CS Sicily Kariuki said the national and county governments will begin implementing the recommendations immediately.
• Sicily noted the report also proposes the Insurance Regulatory Authority should stop regulating the NHIF, with the MoH given more mandate.
Image: WILFRED NYANGERESI
The government will pay National Health Insurance Fund premiums to cover about 30 million Kenyans beginning next year if it adopts reforms by a team of experts.
To be covered under the 30 million are children and other dependants hence the actual premiums paid will be lower.
The experts, appointed to propose reforms for the national health insurer, presented their report to Health Cabinet Secretary Sicily Kariuki yesterday.
They proposed the fund should stop collecting the voluntary Sh500 monthly premiums from poor Kenyans.
The team noted the default rate is high in the voluntary Sh500 national scheme and only 35 per cent of registered members consistently pay their premiums.
Further, the NHIF spends three times more money paying for treatment of Kenyans in that scheme, compared to their contributions.
The experts proposed that instead, the government should allocate funds directly to NHIF to cover uninsured Kenyans and those in the Sh500 scheme - mostly poor Kenyans and those in the informal sector.
Currently, only about 18 per cent of Kenyans are insured through the fund.
The Ministry of Health appointed the NHIF Reforms Panel in February to assess how the fund can be reformed to deliver the Universal Health Coverage beginning next year.
Panel chairman James Wambugu said the Sh50 billion allocated to UHC in the 2018-19 budget would be enough to cover the uninsured Kenyans for one year.
Kenyans in formal employment will continue to make their mandatory contributions, he said.
"For those employed, nothing changes. The benefit is to Kenyans who are not employed," he added.
He said their analysis of the NHIF and international experience shows that UHC cannot be achieved through a voluntary insurance mechanism.
Health CS Sicily Kariuki said the national and county governments will begin implementing the recommendations immediately.
"This 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 said.
The report proposes a near-complete overhaul of the Fund. It suggests an independent organ should take over grading and accreditation of hospitals and service providers.
Health CS Kariuki noted the report also proposes the Insurance Regulatory Authority should stop regulating the NHIF, with the MoH given more mandate.
"The IRA's mandate should be the regulation of commercial insurance. NHIF work will be purely social insurance. It, therefore, remains under the Ministry of Health as a social insurer," she said.
The panel also proposed NHIF collapses all its 74 different schemes into three - employer-paid scheme, civil servants scheme and the tax-based scheme for the poor and Kenyans in informal jobs.
The current 74 active schemes include the Sh500 voluntary scheme, 39 different parastatal schemes, 11 private companies, 16 county governments, civil servants’ scheme, Edu Afya, Linda Mama, HISP, National police and Kenya Prison medical scheme, and older persons and severely disabled scheme.
The report says all those schemes are unsustainable and beginning next year until 2027, payouts in different schemes would exceed contributions.
NHIF premium contributions have increased three-fold, from Sh14 billion in 2013-14 to Sh45 billion in 2017-18.
However, benefit pay-outs have increased five-fold over the same period meaning that growth in benefit pay-outs have outpaced growth in premium contributions.
"This implies that all factors held constant, NHIF’s financial sustainability will be compromised soon," Wambugu said.
All the different schemes began by different counties will also become unsustainable by 2026.
(edited by O. Owino)