Woes of NHIF Beneficiaries From the Private Sector

Workers from the private sector using the National Hospital Insurance Fund (NHIF) medical cover scheme seem not to be benefiting at all even as the insurer keeps on collecting fees from them.

It seems like despite the increased monthly fees and the promises for better services, nothing has been done towards ensuring that both public and private sector workers have access to all the medical facilities covered by NHIF.

Public workers are the only ones who keep enjoying the fruits of NHIF as they can get access to both outpatient and inpatient services from some of the private and public hospital, while on the other hand workers from the private sector continue gaining nothing yet both groups are deducted equal amounts every month.

NHIF cards for private sector workers are being rejected by most hospitals, especially private ones because they have not come to a concrete agreement on the amount that the insurer should give as capitation levels for families.

It is not only private hospitals like Nairobi, Aga Khan and Mater where the private sector workers tend to be denied medical services, but also in some of the major public referral hospitals like Moi Teaching and Referral Hospital and Kenyatta National Hospital too.

As this keep happening, NHIF increased their monthly deductions from Sh.320 to Sh.1700 since April last year, with the promise of advanced medical facilities, something that is yet to be delivered. In fact, it seems to be worsening as only one group of people, who are from the public sector seem to be benefiting.

Private sector works only get access of inpatient services, from some selected middle class hospitals, which do not offer quality services since most of them lack the required facilities. These services offered to them are used to settle some of their bed charges.

All NHIF members have been entitled to a Sh.6,000 maternity cover for normal deliveries and Sh.18,000 for the caesarean section but just recently, the cover was increased to Sh.10,000 for normal deliveries and Sh.30,000 for the C-section. Furthermore, it pays Sh.2,850 for all outpatient services to hospitals for the public sector servants.

It is not clear whether the recently announcement for the agency to be catering for all outpatient treatments for patients with chronic diseases seeking medication abroad to be true, when they have not yet settled medication issues for private sector workers in in the country.

Article by Vera Shawiza.