Kenya Healthcare Federation hospitals to adopt cash-only terms for NHIF patients » Capital News
NAIROBI, Kenya, Mar 15 – Hospitals affiliated to the Kenya Healthcare Federation are set to adopt cash-only terms for National Hospital Insurance Fund (NHIF) patients from next Thursday.
According to the organisation’s Chief Executive Officer (CEO) Tim Theuri, providers will furnish their clients with a duly filled claim reimbursement form as provided by the fund.
Theuri pointed out that this is the only survival tool institutions have following delayed NHIF remittance by the government.
“Dialogue with NHIF over the last one year shows a poorly capitalized organization and the current state of low pay outs means we are staring at an imminent collapse of healthcare,” he stated.
He stated that the current situation, where NHIF reimbursement rates often fall below the actual cost of service delivery poses a threat to the healthcare ecosystem.
“A further estimated KES 6 billion is locked in the old e-claims system since 2017 with no recourse,” he stated.
He indicated further that many healthcare providers, particularly those outside major urban centers, rely heavily on NHIF reimbursements.
“Sample data received by KHF indicates a payout rate of 12.9% of approved
claims. 57.7 percent of providers have not received capitation for managed schemes with industry being owed more than an estimated Sh20 billion,” he stated.
He explained that many providers are micro, small, and medium enterprises and cannot sustain credit periods beyond the timelines indicated in the contract.
“The very act of delaying payments on approved claims is an illegality and a breach of contractual terms. The fragmented nature of the industry, coupled with limited access to traditional financing options like banks due to their financial standing, makes them especially vulnerable when NHIF reimbursements are delayed
or inadequate.”
He revealed that the situation is further exacerbated by the significant depreciation of the Kenyan Shilling since the current NHIF contracts were signed.
“This has drastically increased the cost-of-service delivery due to reliance on imported medical supplies,” he stated.
He stated however that NHIF reimbursement rates remain fixed, creating a growing financial strain on providers.
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