The Government of Kenya says NHIF cannot cover COVID-19 hospital bills for Kenyans in both public and private hospitals because it’s too expensive.
According to CS Mutahi Kagwe, NHIF will not have a financial obligation under globally recognized best practices, or its present model of operation, to finance the testing or hospitalizations related to COVID-19 or other epidemics/pandemics.
The Ministry Of Health says it is not financially viable for the National Hospital Insurance Fund (NHIF) to cover the bills for COVID-19 which are expensive and were not envisaged in the current NHIF premiums computation.
“The cost burden of financing Covid-19 testing and treatment for NHIF beneficiaries both in the National Scheme and the Enhanced Medical Schemes would not be financially viable since it was not envisaged in the current NHIF premiums computation and the existing benefits package,” Health CS Mutahi Kagwe explained to the Senate on Wednesday.
Mutahi Kagwe added that pandemics and epidemics are exclusions in health insurance due to their nature in terms of “cost and risk modeling with the uncertainties, beneficiary access, and claims reimbursements, scope definition and treatment/care plans.”
In late June, the National Hospital Insurance Fund (NHIF) had said that it would only provide cover for COVID-19 to patients admitted to public hospitals however, now, not even those are to have their bills covered.
Previously, the National Hospital Insurance Fund said that its bills dropped by 7,000,000,000 Shillings over COVID-19 because Kenyans spent less on medical bills in the financial year 2020 compared to a similar period in 2019.
According to the NHIF, the decline was a result of the “impact of COVID-19, as job losses may have seen a reduction on premiums contribution”, following the inability to raise funds by Kenyans due to limited income.
Data indicated that the National Hospital Insurance Fund spent Sh13 billion on bills compared to Sh20 billion last year, a 35 percent drop, as maternity services and surgeries topped payments.