NHIF reviews costs for various procedures in its new scheme

The National Health Insurance Fund (NHIF) will pay a uniform rate for deliveries across all hospitals in Kenya under the new enhanced medical scheme.

Women giving birth through normal method will pay Sh10,000 at Level III, IV, V and VI, for both national and enhanced comprehensive cover while charges for C-Section under comprehensive cover has been set at Sh30,000.

In the 2020/21 financial year, the NHIF paid out Sh1.4 billion for C-Sections.

Indeed, there has been an increase in the number of C-Section procedures which rose from 9.5 per cent in 2016 to 14.9 per cent in 2019, according to the Kenya Demographic and Health Survey 2015/16. Most were performed in private hospitals.

Dialysis for kidney patients under proposed rates is Sh6,500 a decrease from Sh9,500.

Patients are also encouraged to undertake at least, three dialysis every week, as per the Kenya Renal Association and international standards.

Radiology, under the proposed rates MRI services will cost Sh9,600, for both comprehensive and non-comprehensive holders, from Sh15,000.

Non-comprehensive cover

The CT scan will cost Sh6,000 a reduction from Sh8,000 for both comprehensive and non-comprehensive cover. Cancer patients in need of mammography will pay Sh6,000 under comprehensive cover, a package that will not be issued for non-comprehensive holders.

The scheme shall also provide basic chemotherapy up to Sh25,000 per session for six sessions, complex chemotherapy up to Sh100, 000 per session for six sessions, radiotherapy up to Sh3,600 per session for 20 sessions.

Brachytherapy will be charged at Sh40,000 per session, Sh15,000 for bone scan for one image every year and Sh40,000 for PET scan, for one image per year.

Other reviews for enhanced scheme include dental, medical check-up will be on referral basis and pre-authorised at a rate of Sh11,700.

Under the new scheme, stand-alone dialysis centres shall be contrasted on a comprehensive basis, and must have an ICU or a service level agreement with a Level Five Hospital having an ICU within a radius of 10 kilometers.

“The proposed rate has been arrived at from analysis of cash paying fees schedules where on average GoK facilities charge Sh5,000 and private dialysis charge Sh6,500,” reads part of the report titled, Deep Dive into NHIF reforms: The Benefit Package which has placed antenatal care and postnatal care under outpatient cover.

National scheme beneficiaries includes anti-snake venom and anti-rabies payable with the package chronic diseases shall include diabetes, chronic obstructive pulmonary disease (COPD) asthma, hypertension, sickle cell disease and mental health.

The new rates proposed by NHIF are aimed at ensuring all Kenyans access quality health-care amid plans to roll out Universal Health Coverage (UHC).

In the reviewed rates, inpatient benefit package for enhanced schemes beneficiaries without limits will be eligible to seek services in non-comprehensive facilities on clinical referral by licensed practitioner at a primary provider and approval by NHIF.

However, private hospitals have complained that the new rates were too low for provision of healthcare, with a reduction of at last 50 per cent. But the Ministry of Health insists the rates will be implemented to guarantee access to quality care for all Kenyans.

Further, the insurer plans to contribute to UHC, increase and sustain revenue, enhance value-based financing and strategic procurement of health care benefits.