One price fits all as new scheme standardises hospital payments

Pricing of health services across all hospitals in the country will be standardised under the new medical scheme.

Health Cabinet Secretary (CS) Susan Nakhumicha said tariffs for charges offered in private, public and faith-based hospitals shall be uniform in the Social Health Authority (SHA).

Nakhumicha said it is worrying that health services in the country are highly overpriced, an issue to be addressed in the new scheme.

The CS was responding to an uproar by health economists and Kenyans that tariffs placed for health services in the new scheme are too low.

For example, among the concerns raised are hospital deliveries that have a tariff of Sh11,200 for normal deliveries and Sh32,000 for the Caesarian Section (c-section).

According to health officials, the allocation is low, an issue that might compromise the quality of care.

“Based on our costing, we shall deliver the service based on the rates. Whether to the public hospital, faith hospital or private hospital,” said the CS.

She said during one of the forums to deliberate on the costs, an oncologist observed that Sh32,000 for a C-Section was not enough.

However, the delivery in the repealed National Health Insurance Fund (NHIF), was set at Sh17,000.

“Under NHIF, C-Section was Sh17,000. Now we are reimbursing Sh32,000,” she said.

According to the official, there is nothing unique done in private and public facilities.

“...Gynaecologists are the same, equipment is same, the medication is same, stitching is the same thing. The input is the same,” she observed, in reference to why charges should be standardised in all hospitals.

The only difference between a private and a public hospital according to Nakhumicha is the comfort of care.

“When I went to deliver my last born at Aga Khan, I was given a private room and there was music for me. Those are things that make healthcare expensive, and there was a nurse rubbing my back throughout the labour and asking what is my favourite music. Those questions are not asked when you go deliver in a public facility,” she said, adding “Without 'music' you can deliver your baby. We have, therefore, cost what is essential,”

Presidential health economic advisor Dr Daniel Mwai said a woman who will access services above the tariff of Sh32,600 for C-Section will be forced to top up out of their pockets.

Before settling on the tariffs, Nakhumicha said a team of experts has been doing costing on health services.

Currently, the tariffs capped on health services are undergoing public participation, and once done, they will be gazetted into law.

“For a whole one and half years, we have been doing costing. So, we know, those figures are based on the cost of items and cost of service,” said the CS during a media sensitisation forum on the tariffs.

As Kenya Kwanza gears towards the actualisation of Universal Health Coverage (UHC), the CS said there is a need to move towards attaining the highest standards.

Benefit package components in the new scheme include medical outpatient services, medical inpatient and critical care services, renal services, assistive devices, end-of-life services, accident and emergency services, oversees treatment, maternity and child health services, oncology services, medical imaging, screening of common disease and rehabilitative services.

Other services include dental healthcare, optical services, surgical and specialised pharmacy benefits.