NHIF Members to Access Private Clinics

The National Health Insurance Fund (NHIF) will now allow members to directly access consultant doctors and private pharmacies in a move aimed at widening treatment options and to control costs.

“The board is currently finalising the roll-out of the model that will offer members more options in accessing healthcare and reduce amounts spent on payment for claims.” said NHIF Chief Executive Dr. Peter Kamunyo.

NHIF presently pays for services through accredited hospitals, locking out consultants operating in private clinics and pharmacies. This has forced its members to meet the cost of buying medicines and finding consulting doctors outside qualified hospitals.

“Right now, we can only reimburse hospitals and that has been a problem. Why don’t we have consultants who charge less, we can negotiate with them because the Act was that we could only reimburse hospitals,” Dr Kamunyo said on Monday.

“Now we will be more creative in cost containment, adding quality and value to our members. The (NHIF)team is working very hard to ensure we get there because this is one of the big-ticket items (needed) to achieve quality and cost containment.”

This shift is riding on changes to the NHIF (Amendment) Act, 2022. It now allows the State insurer to directly contract individual healthcare professionals to provide consultancy, preventive care and other services.

Previously, law restricted the NHIF to public, private and faith-based hospitals for inpatient and outpatient services. Now, the NHIF will negotiate the payment rates with private clinics and pharmacies as it races to adopt the business model pursued by insurance firms.

The fund did not provide details of how its members will access the planned service. Official data shows that Kenya had 13, 376 registered doctors and 4,285 registered pharmacists as at December last year. The NHIF is betting on its wide membership of 13.8 million to negotiate fees lower than the market rates.

Article by: Leonard Selelo