Hospital services now free for NHIF members – Kagwe

This was after the fund and health facilities agreed on new contracts.

Health CS Mutahi Kagwe said this benefit applies only to procedures that are within the scope of the cover.

“The contracts will be either comprehensive where the members will walk in and walk out without paying or non-comprehensive whereby if a member chooses to go to a facility, then they would top up,” Kagwe told journalists at NHIF headquarters.

He said 80 per cent of all service providers – comprising all public and most mission facilities –indicated they will sign comprehensive contracts.

Nearly all private hospitals choose non-comprehensive cover, meaning NHIF members will top up to access services there.

The new contracts take effect on Friday this week.

The fund also abolished the system where it paid private hospitals more than public facilities for the same services.

Kagwe said this was stopped following a public outcry because most money ended up in expensive health facilities.

“The new contracts accommodate the concerns of Kenyans and accredited hospitals through standardisation of reimbursement rates across all healthcare providers as per the Kenya Essential Package for Health levels of care,” he said.

However, the reimbursement has increased by 12 per cent across all providers.

All health facilities will also receive more money to serve outpatients, covering seven categories of lab tests.

The new contracts also expand the surgical benefit package from 292 to 549 procedures, including interventional radiology, cardiology and maxillofacial surgeries.

“Radiology, medical imaging benefit has been enhanced to include access to mammography, fluoroscopy, Echos, EEG (test to monitor brain-related conditions like epilepsy), and specialised ultrasound imaging,” Kagwe said.

The new contracts also cover mental health, bone scans and PET scans for cancer patients, at the Aga Khan Hospital, KU Hospital and a mission hospital in Kitui.

NHIF said unless a patient has an emergency, it is important to know the category a hospital belongs to before seeking inpatient services from it, to save money.

“Members will access services in more than 7,600 healthcare facilities spread across the country, of which 80 per cent are comprehensively contracted,” Kagwe said.

The contracts should have been signed last year but NHIF reduced rates for services it considered overpriced, leading to protests from health providers.

However, NHIF boss Peter Kamunyo confirmed yesterday the old rates had been retained in the new contracts, and enhanced by 12 per cent.

The cost for two weekly dialysis sessions, however, remain Sh9,500 per session.

In January, Health CS Kagwe had also complained NHIF had been paying too much to private hospitals, attributing it to medical fraud, including impersonation of beneficiaries.

Claims by contracted facilities jumped from Sh19.7 billion in the financial year 2015-16 to Sh54.6 billion in 2020-21, Kagwe said.

The amended NHIF Act allows the fund to review rates paid to contracted facilities once every two years.

Edited by A.N

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