NHIF: Health Ministry Suspends Outpatient Limits and Key Milestones To Note

 “The Cabinet Secretary for Health Dr. Cleopa Mailu has suspended with immediate effect the decision by NHIF to limit the outpatient visits to only four per year until further notice. This is until further consultations are held between NHIF board and other stakeholders. Meanwhile, patients should continue the services as it has been the case before.”

National Hospital Insurance Fund (NHIF).

The National Hospital Insurance Fund, commonly known as NHIF, has been synonymous in Kenya’s health sector in terms of helping foot the medical bills of its members.

The fund often registered all eligible members from both the formal and informal sector. For those in the formal sector, registration for NHIF is compulsory while for those in the informal sector as well as the retirees, membership is open and voluntary.

For many years, NHIF has been going through various developmental phases in an effort to make the services more accessible and affordable even to the most vulnerable members of the society. What many Kenyans don’t know is the NHIF’s core mandate is to provide medical insurance cover to all its members and their declared dependants (spouse and children) with its membership open to all Kenyans who have attained the age of 10 years and have a monthly income of more than 1000 shillings.

In order to make its services more available to more than 6.5 million of its members, NHIF added to its list a total of 204 public, private, and faith-based hospitals and dispensaries to its list of accredited facilities. Some of the top hospitals that made it to the list included Aga Khan Hospital Kitengela, Gertrude’s Garden Children Hospital Nairobi West Clinic, Gertrude’s Garden Children’s Hospital Nyali Medical Clinic, and Texas Cancer Centre Eldoret.

READ: Kenyans To Benefit From Additional NHIF Accredited Facilities 

Until recently, NHIF was only according to services to inpatients but the month of November kicked off with good news for most NHIF members. The members were set to get outpatient treatment at any facility using the National Hospital Insurance Fund (NHIF) card.

In a statement, NHIF said that it was responding to the needs of its beneficiaries and at the same time adapting to the changing market dynamics while promoting the aspiration to universal health care coverage with a view to facilitating access to affordable, sustainable, equitable and quality social health insurance.

However, in the new directive, the hospital needs to be “on preferences basis from a list of designated facilities provided by the fund countrywide effective from 1st of Nov 2017.” Initially, NHIF beneficiaries were required to select hospitals that they can easily access for outpatient services.

READ: NHIF allows patients to have choice on outpatient facility

However, the new directive came with its own limitations. The members who were to seek outpatient services were to do so only four times a year. With only four outpatient visits a year, this meant that the members were looking at huge medical bills in the event that their visits were more than four. By limiting the number of visits to four, what this directive also meant was that, for a family of four that depends on a single NHIF card, for instance, will have one outpatient service each in an entire 12-month period.

When the directive was given, Kenyans took to social media to shower praises to the fund concerning the move. Some, however, took issues with the Fund’s move to limit the number of visits for outpatients to only four. To have this changed, a petition was set to motion, “Petition NHIF to revise its rules on outpatient visits” and by 3rd November 2017, more than 8,000 Kenyans had signed the petition.

“No one is asking for an unlimited cover. Controls have to be put in place, but the same must be well thought of so as not to deny vulnerable persons the financial access to health services. There are better and more elaborate ways of curbing fraud, less of which occurs in the public hospitals as far as outpatient claims are concerned. Capping of the amount and visits to such a small scale in the context of the average Kenyan family size is not a creative way of containing costs. By signing this petition, we recommend the immediate halt on such ridiculous caps and require NHIF to engage stakeholders to ensure equity of cover as we progress towards achieving Universal Health Coverage for Kenya,” read part of the petition.

The petition seems to have yielded fruits as the Health Cabinet Secretary Cleopa Mailu moved to suspend NHIF decision to limit outpatient visits to four in a year.

In a press statement Saturday morning, Mailu said patients should continue enjoying NHIF services without limits. “The Cabinet Secretary for Health Dr. Cleopa Mailu has suspended with immediate effect the decision by NHIF to limit the outpatient visits to only four per year until further notice. This is until further consultations are held between NHIF board and other stakeholders. Meanwhile, patients should continue the services as it has been the case before.” Read the statement from CS Mailu.