Limit on dialysis sessions puts lives of patients at risk

A nurse at Moi Teaching and Referral Hospital in Eldoret checks up on a kidney patient on January 30, 2018. PHOTO | JARED NYATAYA | NATION MEDIA GROUP

What you need to know:

  • NHIF’s chief executive officer Geoffrey Mwangi said patients and hospitals have been aware of policy limits but have been ignoring them.
  • The insurer’s payouts for dialysis in 2017 were the largest overall, highlighting the growing burden of kidney disease in the country.

Hundreds of thousands of patients with kidney problems will be forced to pay extra money for dialysis every month after the national health insurer, which has been bearing the burden, started restricting the sessions to 10 a month.

The National Hospital Insurance Fund says it will start demanding pre-authorisation from hospitals for any extra dialysis sessions above the maximum number per week.

With more than four million Kenyans living with kidney ailments last year, this new directive means hundreds of thousands of patients who require more than two dialysis sessions a week will have to start paying for the extra service or live with the pain.

TREATMENT COST
Already, our investigations show patients who need more than two weekly sessions on dialysis machines have stopped seeking the extra care after they were slapped with bills last month.

However, NHIF says this is not a new policy, but a guideline that has been ignored in the past.

The process of seeking pre-authorisation could either delay or deny poor patients life-saving treatment, and the Nation on Wednesday learnt that most hospitals have stopped requesting the Fund to foot the extra bills.

Instead, they are asking the patients to pay for every extra dialysis session.

The problem, however, is that most of them cannot afford the charges, and so they are going without treatment. On average, a dialysis session costs Sh9,500.

PATIENTS
One of the affected patients, a government employee who requested anonymity for fear of being victimised, said her request for extra funding was rejected earlier this week.

“I depend on dialysis to survive and I can’t miss any session since I have not found a donor,” she said.

“This is my life and I am appealing to the Fund to consider revising its sessions limit.”

Because she is a civil servant, she contributes Sh1,500 every month to NHIF and does not understand why the benefits for such a crucial service would be limited so much.

“They should have made a formal announcement regarding the cap instead of leaving it to hospitals to regulate,” she added. “All members should have been informed in advance.”

Another patient, Mr Emmanuel Odhiambo, went for dialysis but was turned away as he did not have the cash.

“I would have paid for the extra session if I had the money,” he said.

“This is very important to me as it could determine whether I live or die, but I cannot afford it.”

CONTRIBUTION
NHIF’s chief executive officer Geoffrey Mwangi said patients and hospitals have been aware of policy limits but have been ignoring them.

He said treatment also depends on the package one is on, suggesting that approvals for extra sessions rely on how much one contributes monthly.

The insurer’s payouts for dialysis in 2017 were the largest overall, highlighting the growing burden of kidney disease in the country.

Official records indicate that NHIF paid hospitals Sh839.9 million in the six months to December, up from Sh139.8 million in a similar period a year earlier.

It received 86,776 claims for dialysis in the first half, compared to 37,177 in the same period a year earlier.

KIDNEY TRANSPLANT
High blood pressure — or hypertension — and diabetes are the most common causes of kidney disease.

High blood pressure, for instance, is reported to cause just over a quarter of all cases of kidney failure.

Only two public hospitals — Kenyatta National Hospital and Moi Teaching and Referral Hospital in Eldoret — have the capacity to conduct kidney transplants at subsidised rates.

Acute kidney patients on dialysis are often referred for transplants, but since most of them do not have donors, they are forced to continue with dialysis for survival.

The NHIF pays Sh500,000 for a kidney transplant at private hospitals like MP Shah, which charges Sh2 million for each transplant outside the NHIF cover, underlining the huge benefits of the government-backed cover, especially for low-income households.