•For each medical intervention, different categories of packages apply.
•Data shows that between 2011 and 2021, NHIF has catered for 665 inpatient cases of multiple sclerosis and neuromyelitis.
Image: FILE/ DOUGLAS OKKIDY
The National Hospital Insurance Fund is considering developing a stand-alone package to address the growing health needs of patients with multiple sclerosis.
Multiple sclerosis is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
It's a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
The decision comes after patients and guardians petitioned the Senate Health Committee demanding that the bills be catered for by NHIF.
NHIF has been covering beneficiaries suffering from MS and neuromyelitis through the existing package for those requiring admission for inpatient symptoms management.
“Depending on the applicable scheme, beneficiaries are covered through daily rebate or fees for service,” CEO Peter Kamunyo said.
"This coverage is comprehensive in government and most contracted faith-based and low-cost private health facilities,” he said.
Kamunyo said the insurer caters for patients requiring dialysis, CT and MRI scans, those who may be prescribed immunotherapy drugs like atezolizumab, nivolumab and those requiring surgical interventions.
For each medical intervention, different categories of packages apply.
For instance, those who require immunotherapy drugs benefit under the oncology package while the imaging package applies to those in need of CT and MRI scans.
“Those requiring intervention like bone marrow transplant overseas, the foreign treatment package applies,” Kamunyo said.
Data shows that between 2011 and 2021, NHIF has catered for 665 inpatient cases of multiple sclerosis and neuromyelitis.
They are 24 cases of neuromyelitis, 328 cases of unspecified systemic connective tissue disorders, 260 cases of systemic disorders of connective tissue in other diseases and 53 cases of neuromyelitis optica.
Kamunyo said for the population to be covered, the impact on quality of life and disability-adjusted life years, the affordability and sustainability of the benefits in the context of premiums paid and other available sources of health financing are key in determining the depth of benefits coverage under social health insurance.
“Health insurances choose the allocation of health care financial resources in a context of the underlying problem of scarcity of resources, which dictates that not everything that offers a benefit can feasibly be funded and the principle of forgone benefits (opportunity costs).”
Experts estimate that a patient on immune suppressants requires at least six vials in a month, each goes for Sh250,000.
This means a patient requires at least Sh1.2 million for drugs alone.
Marion Juma, an advocate of the High Court, was lucky to undergo a stem cell transplant in Mexico in 2017.
The process costs between Sh4.5 million to Sh6 million, throwing doubt on the affordability among ordinary citizens who are affected by the condition.
Kenya currently has only 18 specialists, all based in Nairobi, posing a challenge to patients in the rural areas who have to travel long distances to seek treatment.
Edited by Kiilu Damaris