Private Sector’s engagement with NHIF panel

Kenya Healthcare Federation to engage the NHIF reforms panel

The Healthcare Financing committee(HCF) of Kenya Healthcare Federation held their first meeting for the year 2019 on 12th April 2019 at KHF offices. The meeting was chaired by the committee director Dr. Walter Obita. HCF committee is mandated to oversee the UHC discussions and planning and it’s also the backbone of UHC from the private health sector. National Hospital Insurance Fund (NHIF) is currently undergoing reforms and the Cabinet Secretary, Ministry of Health, Mrs. Sicily Kariuki, appointed a panel to look into recommendations toward reforming NHIF. KHF through HCF committee needs to have proposals towards reforming NHIF

The committee met the NHIF panel and presented recommendations from the private sector to the NHIF reforms panel in restructuring and reforming NHIF will included; NHIF recommendations should cover its structure, operations, legislation, accreditation, reimbursement framework, quality of care, its core mandate and role of other stakeholders, there should be a system that monitors the financing of health programs to avoid overlapping and thus save cost. Healthcare providers claim for the same service from NHIF, private insurers and Non- Govermental Organization(NGOs) financing these programs, In order to achieve Universal Health Coverage( UHC), NHIF need to promote cover of non-contributors who are the poorest and cannot afford to pay, there is need to track the NHIF recommendation and reforms by the panel because part of the NHIF reforms also includes how NHIF will implement UHC when it rolled out to the other 47 counties, NHIF management structure and governance needs to be competitively recruited.

The composition of the NHIF board which is in the NHIF act should be stronger with wider stakeholder representation including private sector, the private sector insurers reimburse their members based on use of their medical benefits. NHIF focus on provider payments instead of member benefits this opens a channel for corruption. KHF advocate for NHIF to change from focusing on provider payments to member benefit, NHIF should increase the efficiency, speed and transparency of processing claims as well as change their way of administration. Need to redefine the core mandate of NHIF, NHIF accreditation tool was designed for hospitals only. Different levels of care should have their own accreditation tool so that level 2 and 3 health facilities are given the chance to offer primary care, there should be a key focus on quality of care offered in health facilities Incentives on performance-based financing focusing on outcomes needs to be put in place. KQMH should be the minimum standards used across all health facilities,
the capitation rate set by NHIF is also on provider focus and not member focus. The capitation rate was poorly calculated and the annual amount 1,200/- that includes all drugs, laboratory covers, consultation etc. has promoted provision of lower quality out patient care.

KHF directors and health care financing committee met with the NHIF panel and discussed the above recommendation. As a way forward the committee was requested to Share any accountability mechanisms for NHIF that has worked in the private health schemes e.g. fraud prevention, e-Governance, Be specific on the sources of funding for NHIF as elicited on NHIF on how to increase the resource pool, share any data on health insurance that we may have for NHIF review. Share ways of improving the ecosystems as an enabler for NHIF e.g. the Healthcare Finance Strategy, any legal reforms, how to make NHIF more prominent in the Primary Healthcare space. It was agreed that all the information collected from the private sector will be discussed by the panel and feedback shared to the private sector.

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