NHIF needs to explain benefits to its members, clear ambiguity

I was not surprised to get a rejoinder from someone who introduced himself as an NHIF official following the July 1 article in this column, ‘NHIF discrimination is what needs debating, not MPs Pay”.

Nonetheless, it is still my opinion that the national health insurer is discriminatory in its current set-up. Unless we rethink how to roll out NHIF benefits that are accessible to all Kenyans equally regardless of their status in society, we will continue to hurt the poorest citizens by freezing them out of quality healthcare.

The NHIF is the best thing that ever happened to this country and I’ve intimated as such in a few of my previous articles. I truly believe so. But it does not mean that the NHIF is above reproach or that we should accept it warts and all, just to be sycophantic.

IMPROVING THINGS

I feel concerned enough about the poor level of healthcare in this country to comment on it several times. It is my way of contributing to improving things. In that regard, I always aim to use my column responsibly by informing, educating and criticising wherever necessary.

I’m that citizen and NHIF service user, too, at the end of the day. Neither would I pluck evidence from the air.

That said, I have had interactions for a couple of years now with both public and private hospitals through my mother to warrant my comments. I’ve also interviewed fellow service users.

I understand first-hand the discrepancies in the NHIF benefits. I, therefore, stand by my views and hope that they will help to shape our healthcare for the better. That has always been my intention and always will be.

LABOUR LAWS

Having said that, I’m intelligible to labour laws; but that does not mean standing by its rules when they hurt a cross-section of the population. It’s all encouraging for civil servants to benefit from a better NHIF cover by virtue of being government employees, but it does not mean allowing for glaring discrimination against a section of the population on lower NHIF to go on unchallenged.

I, therefore, believe that we must work towards a healthcare scheme that would befit both the President and the pauper.

The Netherlands recently shared with us their model of healthcare, where insurance is paid equally across the board and just about any citizen, regardless of class or creed, can access it.

The United Kingdom’s National Health Service (NHS) is also based on national insurance contribution by employees and public hospitals get the lion’s share of funding from it. And it benefits all citizens equally.

SUPERCOVER

The NHIF’s folly is that it has not honestly and fully explained its benefits to subscribers. For instance, its SupaCover offers a multitude of benefits on a Sh500 monthly premium. But it gives the impression that the benefits would accrue to those who choose to attend private hospitals that have an agreement with the government to accept patients on the NHIF cover.

The truth is that private hospitals cherry-pick which service to offer and, in many such cases, one gets the barest minimum. The patients are still exploited financially when they end up having to dig deep into their pockets to bridge the shortfall.

The agreement between the State and the private hospitals does not make it clear whether patients can get all the benefits from their policy in these facilities or just partial. This is misleading to the patients.

It seems to be some sort of easy marketing for private hospitals to get patients through their doors where they still milk their clients dry. The NHIF should either be fully utilised in public hospitals or make it categorically clear what benefits can be obtained in private hospitals and which are covered in public hospitals.

PUBLIC HOSPITALS

The insurer should consider whether it’s appropriate for public hospitals to still outsource laboratory and pharmacy services to the private sector despite informing patients that these can be obtained in public hospitals as part of the cover. Is the NHIF bent on benefiting the private sector at any opportunity or is it there for patients?

Also confusing is the idea of having to wait for NHIF approval for things such as CT scan and certain medication in public hospitals. This hurts patients, who have to wait for a long time for the services.

The policy of ‘notification’ window of 24 hours or so after a patient is admitted is rigid, cruel and insensitive. Patients end up paying exorbitant hospital fees for not notifying NHIF of their admission to hospital.

There are many valid reasons for such omission — like illiteracy, being in a coma or having no one to chase up NHIF.

The NHIF should have an effective trigger system between them and the hospitals from when a patient is admitted in order to save subscribers and their families further financial headache.

Let the NHIF be transparent to be better understood.

Ms Guyo is a legal researcher. [email protected] @kdiguyo