Divorce NHIF from private hospitals

Private hospitals in Kenya are greedy for money. I don’t need to explain that to many Kenyans who have had to sell property to pay for their loved ones or themselves the exorbitant fees charged by private hospitals. Neither do I need to explain to those imprisoned in private hospitals for lack of fees.

The idea of enjoining private hospitals in the NHIF programme was doomed to fail from the beginning. Their interest is not patient care but profit.

Yet universal health coverage (UHC) expounds the ethos of easy accessibility to healthcare that comes with minimal financial hardship to patients.

The situation for most patients is that the UHC system modelled around NHIF and private hospitals is too expensive and unachievable by most ordinary Kenyans. I have never understood what informed the decision. Clearly, there was no public consultation to this effect to understand how private hospitals in Kenya have adversely affected patients financially. Had there been one, perhaps the policymakers would have known a better way to roll out UHC and manage NHIF for its members.

Political class

I’ve argued that healthcare in Kenya is a tiered system like most other services. The best care and services often go to the political class with influence, as MPs are doing, to get higher pay and perks like private health insurance. They leave the dregs to ordinary Kenyans in half-baked policies.

Those making policy on NHIF and UHC should be focused on improving public healthcare in its totality where NHIF fits better and be the first in the queue to share those facilities with the people who elected them.

They need to walk in the shoes of their electorate and not walk on their socioeconomic rights with their shoes. That is what seems to be happening in the health sector as poor Kenyans continue to struggle to access affordable quality medicare.

Private hospitals love not poor patients but their money. Even then, they are stingy on their offers to NHIF patients. I’m sharing this from personal experience. Some private hospitals and clinics turn away NHIF patients because they prefer those with private insurance or company medical schemes.

That makes it harder for NHIF members and it can put patients at risk, even of death, as they or their relatives scour the town looking for a private hospital that will accept the patient. This goes for in-hospital stay, lab, pharmacy and imaging services too.

Dogged by corruption

Like many other institutions in the country, NHIF is dogged by corruption involving its staff and private hospitals associated with it.

Claims of private hospitals defrauding the fund are rife—which proves the insatiable appetite private hospitals have for money. The first flurry of corruption allegations involving private hospitals should have been enough to sever ties with NHIF.

Inclusion of private hospitals to help with broadening the scope of UHC was wrong and there is a need for urgent review of this to save patients from further suffering. The natural home for NHIF is within public healthcare with county and national referral hospitals given the core role in driving UHC forward.

That would require improvement of standards at public hospitals so that they can offer all services covered by NHIF under one roof. This move will not only help to speed up patient care but also make it easier to track and trace corrupt activities.

The idea of outsourcing consultation, pharmacy, lab and imaging services to private hospitals undermines the growth of public healthcare and leaves NHIF and patients exposed to abuse by unscrupulous doctors, hospitals, pharmacies and labs. It does not mean that the private healthcare practitioners will make it easy for public hospitals to thrive.

It is expected, they will, in their corrupt and greedy way, undermine their services. It’s up to those elected to protect patients by ring-fencing public healthcare funds and protecting NHIF, patients and public hospitals.

Both the UHC scheme and NHIF are important and crucial steps the country has taken in recent years and, for them to succeed, there is a need to grow them away from the predatory private healthcare institutions.

Opening up NHIF to private healthcare is akin to leading patients to abuse—gagged and chained—and patient abuse is exactly what many private hospitals are doing by charging extortionate high fees.

Regulating private healthcare fees is only a sticking-plaster solution. Private hospitals will always find ingenious ways to overcharge. Again, their sole interest is money, not patients’ welfare.

It could be worthwhile asking NHIF members to increase their premiums to raise more money for public hospitals. However, we need to fight corruption and improve services in public hospitals to offer all manner of care under one umbrella.

Don’t scrap NHIF; boost its funds and protect it for the sake of Kenyans and public healthcare.

Ms Guyo is a legal researcher. [email protected]. @kdiguyo