NHIF caps hospital visits to 4 a year per member
As the National Hospital Insurance Fund (NHIF) continues to expand the coverage of health insurance to Kenyans, it has also capped the number of visits to ensure the scheme remains sustainable.
According to NHIF, members will be limited to four hospital visits a year and will have to seek special clearance from the state owned health insurer to continue accessing services.
Speaking on Thursday, NHIF chief executive officer Geoffrey Mwangi said the newly effected changes will help the fund prevent abuse of health financing while improving service delivery to members.
The decision was informed after introduction of the fixed fee for service package that will see NHIF members access their benefits without having to choose an outpatient facility.
Mr Mwangi said the additional package will enable members’ access 24 hour facilities at NHIF accredited facilities based on their medical needs.
“When you change a payment mechanism .They all come with their scientific way of implementing you realize capitation on the other hand throws risk at the door of the provider and they are able to cap unavoidable visit. When it is on a fixed fee for service we have to ensure unnecessary visits can take care of that. We also give member responsibility and have a way of controlling that’s why you see that capping of four visits per card,” said Mr Mwangi.
Unlike the NHIF, private insurers issue cash limits to policy takers.
NHIF collects between Sh150 and Sh1,700 from members depending on their salary scale and a flat fee of Sh500 from those self employed.
The NHIF boss added that workers in Kenya’s informal sector are being largely bypassed by the benefits of NHIF covers with abject poverty and ignorance remaining stumbling block to many who lack the crucial card.
“The gap we have is in the informal sector where we don’t have any mode of uniting mechanism and it’s left to voluntary way of making your contribution and that’s why we are encouraging those people in the informal sector to make up contribution and they have a mode of insurance with them,” he stressed.
Mwangi said addition of new members who would be drawn from the informal sector would be responsible for the growth.
NHIF has been up scaling its operations to boost coverage recently adding products such as MRIs and surgeries to its offering.
The state health insurer has at the same time scrapped the co-pay element, where members used to pay a certain amount to access health care services.
Additional reporting Denis Otieno
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