About 80 percent of the National Hospital Insurance Fund (NHIF) members defaulted on their monthly contributions to the fund, leading to a loss of at least 36 billion shillings. All the defaulted members come from the informal sector.
Only 1.6 million of the 8.1 million registered informal sector members were making the 500 shillings monthly contributions, exposing millions of Kenyans to out-of-pocket medical bills. The number of Kenyans opting out of NHIF has been growing.
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There have been complaints from a section of Kenyans who contribute to the fund voluntarily that when it comes to covering the costs, NHIF prefers paying for civil servants as compared to voluntary contributors. Many hospitals that accept NHIF tend to shy away from those in the informal sector.
The default has hit an all-time high even as President William Ruto ordered the monthly contributions for the voluntary contributors to be reduced from 500 shillings to 300 shillings. Even with the reductions, Kenyans are still skeptical.
A report says the voluntary contribution option is draining the NHIF since the majority of those keeping up with payments have chronic sicknesses, meaning they utilize the insurance coverage regularly.
“NHIF has lost revenue of Sh39 billion due to these policy lapses. The new law (for compulsory contributions) which cures this issue needs to be implemented urgently. The remaining active group tends to be sicker and claims twice as much from the expected level,” said the report.
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Last year, more than 660 private hospitals threatened to pull out of outpatient services for the members of the National Hospital Insurance Fund (NHIF). The hospitals were protesting a mismatch in capitation rates and delays in signing contracts.
The hospitals said NHIF branch offices have been asking for invoices quoting 1,000 shillings rather than the agreed 1,400 shillings per beneficiary per year. They also said NHIF is yet to distribute physical contracts for the 2022-2024 cycle exposing them to potential legal hurdles.
“We are in a state of limbo as to whether we should serve NHIF outpatient or not because we run the risk of not being paid adequately,” said Dr. Samuel Mwenda, the chairman of the Kenya Faith Based Health Services Consortium (KFBHSC).