Healthcare is a very expensive yet crucial sector in any economy. It is for this reason that governments engage in health financing strategies meant to protect the poor, vulnerable from the financial hardships they may face as a result of seeking health services. One must not be left to choose whether to seek treatment or forgo it and feed the family. Health is a basic need. This is the reason why Kenya has the National Hospital Insurance Fund (NHIF). This social insurance pools funds from members then uses them to purchase for health services at a subsidised cost in order to protect the members from financial hardships that come with having to pay for those services on their own.
However, if recent issues pertaining the usage of the fund are anything to ho by then, NHIF has lost its mandate and is now operating contrary to what it is supposed to do.
In a memo dated 7th January 2020, NHIF has made changes to it membership, changes that already took effect on 1st January of this year. This they say is following a special full board meeting held on 17th December 2019 and meant to take the country towards attainment of universal health coverage (UHC). What an irony?
In the new changes, newly registered members will have to wait for 90 days before they can enjoy the benefits. Within this period, one has to make a 1year upfront payment before they are deemed eligible to enjoy benefits.
NHIF has also proposed stringent punishment for delayed payments and defaulters. Defaulters will have to pay a penalty of 50% (equivalent to 250/-) for each month paid late. On top of this, they will be expected to pay a 1 year upfront payment and will be restricted for 30 days before being eligible for benefits.
Maternity benefits have also been restricted to 6 months after maturity of the NHIF card and/or after being declared a beneficiary. For medical inpatient and outpatient dependents, a waiting time of 30 days shall apply. One will have to wait for 6 months to get access to specialised services.
The number of dependents has also been restricted to include only one spouse and a maximum of 5 children.
Reactions from Kenyans
These new changes have generated a heated debate among Kenyans as they are clearly seen as a step in the wrong direction. Many are now left questioning the government’s policies who they are meant to benefit. While NHIF is meant to bridge the gap between the poor and the financially able in terms of access to health services, these new changes widen that gap and lock out the poor and vulnerable. They restrict access to health services, reduce level of financial protection and reduce fairness of financial contributions towards health. The changes promote out of pocket payments (OOPs!) which is exactly what UHC is meants to do away with.
It looks like the government through National Hospital Insurance Fund is signing a death warrant of the noble initiative. It’s now obvious that unless they make it compulsory for all employees, many individuals will deliberately opt out to finance their own Medical Schemes as it would be cheaper that way.
NHIF vs UHC
Universal Health Coverage (UHC) is a government initiative that seeks to provide all people with access to needed health services of sufficient quality to be effective while protecting these people from financial hardships due to seeking health services. It is premised on the fact that use of health services should be based on health needs rather than the ability to pay.
UHC is meant to reduce out of pocket payments and protect citizens from the catastrophic and impoverishing effects of out of pocket payments.
It also seeks to promote equity in financial contribution for health such that the poor do not pay highly for health while the rich pay less in comparison to their incomes.
NHIF is a means of pooling resources. According to WHO, a good pool must be large in size, have a diverse risk mix and compulsory in participation. NHIF clearly doesn’t meet any of these and the new changes move it further away from being a good pooling system. The changes reduce the size of the pool by locking out the poor and vulnerable. This in turn reduces the diversity of risk mix. Participation is voluntary and that is also one major problem. It should be compulsory for one to have an NHIF. One shouldn’t seek for registration after they fall sick and need financial help.
Impact of New Changes
The changes have a bearing on the purchasing of health services. We cannot put restrictions on when one can be able to purchase critical health services like maternity and specialized care.
Insistence of one year upfront payment discourages membership especially among the poor and other disadvantaged citizens. It also leaves out the majority who are not employed. The unemployed, self employed, those working in the informal sector and interns and volunteers are not favoured by these policies. They have no constant source of income to meet these requirements.
The penalties for delayed payment does not take into account the tough economic situation in the country. It does not take in the fact that counties can stay for 3 months without paying workers. This means all those working with the counties, for instance, will be defaulting payments several times in a year and will always be paying penalties and subjected to long waiting periods.
In a nutshell, one may actually go for a year paying penalties but not able to enjoy the benefits of NHIF coverage.
It also fails to factor in the challenge of employers not remitting NHIF deductions on time and at all as has been the case with counties and universities.
Many have been left questioning whether NHIF is a social insurance or a corporate insurance. The changes lock out the majority poor while collecting maximum money from those able to contribute. It is shocking that the new changes only favours the rich at the expense of the poor and the vulnerable that it should actually focus on.