Healthcare Providers Mount Pressure On NHIF To Halt Proposed Changes In New Contracts

The National Hospital Insurance Fund (NHIF) is under pressure from healthcare providers to halt changes proposed in contracts for the 2022-2024 period to allow further deliberations.

In a joint statement to newsrooms, the Kenya Association of Private Hospital (KAPH), Rural Private Hospital Association of Kenya (RUPHA), Kenya Dental Association (KDA) and Kenya Medical Association (KMA) claim the process of developing the contracts was unprocedural to the extent that meaningful engagement of healthcare providers was ignored.

The stakeholders claim the state-backed insurer is yet to issue them with any draft contract documents that would form the basis of a meaningful engagement or public participation as required by law.

NHIF is accused of having unilaterally issued contracts to some health facilities for summary execution, in certain instances within a 24-hour period.

Read: Ksh6.3 Billion Scandal Ails NHIF, Ropes In NYS, Civil Servants

“Our input was not sought and save for a few providers, we are not privy to the contents of the contracts currently being circulated for execution,” read the communique dated December 23.

The associations argue that rushed execution of contracts without adequate time for perusal and subsequent implementation would be counterproductive since some of the proposed changes may be of a material nature, with significant impact on patient care, the sustainability of the medical schemes and the viability of healthcare provider institutions.

“The contracting process should be halted with immediate effect until our associations formally receive copies of the draft contracts as currently prepared, peruse the contents, engage our members, get legal advice as required, engage NHIF as required and have our concerns addressed,” the healthcare providers said.

“Only after the foregoing would we [be] competent to communicate an informed advisory opinion to our member facilities.”

They further stated that medical benefit packages were developed without proper stakeholders’ involvement and have the impact of lowering the quality of healthcare services to the public if implemented as proposed.

“A point in case is the cutting of the number of sessions that NHIF will pay for dialysis of renal patients without due consideration of the outcome of the treatment for these vulnerable groups,” they said.

“Stakeholders to be involved in formulating sound medical benefits package that will guarantee affordable quality health service delivery.

“…We are also, via this communique, advising all our members against signing any contracts issued to them by NHIF branch offices until such a time that the associations shall advise to the contrary.”

NHIF, Kahawa Tungu understands, has proposed to cut down on the reimbursement of Ksh9,500 to patients undergoing hemodialysis to Ksh6,000 despite concerns from the stakeholders.

The reimbursement was effected in 2017. It led to the mushrooming of very many hemodialysis units.

Although many patients now had access to hemodialysis, research shows, the resultant effect was poor standards of care due to the lack of national oversight.

In addition to the latest demands by the healthcare providers, the Kenya Dental Association has called for wide consultations when developing the benefits package which has largely also omitted oral health benefits to Kenyans.

“Oral health is linked to general health and is direct known cause of some non-communicable diseases. Additionally, there has been inclusion of contracting without a scope of practice document for some cadres which is not in keeping with the best practices,” they said.

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