The call comes after the fund increased reimbursements to hospitals by 12 per cent and rolled out new contracts.
The fund has been paying about Sh40,000 for the PET scan once a year at the Aga Khan Hospital, Kenyatta University Teaching, Referral & Research Hospital and the Our Lady of Lourdes Mutomo Mission Hospital in Kitui South.
But nuclear medicine specialist Dr Harish Ngaraj said the fund should now raise the scans to three.
“We are in discussions with NHIF to see if they can pay for three sessions because for some types of cancer we need to see how the disease has progressed and how effective the treatment is before we continue,” he said.
Dr Ngaraj heads the department of Nuclear Medicine & PET CT at the KU hospital.
He spoke at the hospital’s first annual health conference, which focused on cancer care.
PET scan is an advanced nuclear imaging technique used to look for cancer and its spread.
“It also helps oncologists in staging cancer and monitor treatment, so only one session a year is not enough,” Dr Ngaraj said.
Many institutions outside Kenya impose a limit of three PET scans in a year, and even then multiple scans should not be done unless there is evidence they would help.
Last week, NHIF said patients getting PET scans at Aga Khan may be required to top up because the facility signed a non-comprehensive cover contract.
Those getting PET at KU hospital and Mutomo hospital in Kitui may not need to top up because those facilities have comprehensive contracts.
Last week, Health CS Mutahi Kagwe, while launching new contracts with hospitals, said patients with NHIF cover should not pay anything in public and most mission hospitals, even when admitted.
He said this benefit applies only to procedures that are within the scope of the cover.
“The contracts are 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 would sign comprehensive contracts.
Nearly all private hospitals chose the non-comprehensive cover, meaning NHIF members will top up to access services there.
The new contracts took effect on Friday last week.
The fund also abolished the system in which 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.
The KU scientific conference will take place every year under a different theme.
Prof Wangari Mwai, KUTRRH’s director for Training, Research and Innovation, said next year will focus on cardiology.
She said they chose cancer this year because of the growing burden where about 40,000 people are diagnosed every year.
Mwai advised Kenyans to embrace early detection to avoid going for treatment too late.
“Managing cancer is expensive and this stresses people,” she said, noting that the disease places a heavy economic burden on families.
(edited by Amol Awuor)
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