Covid-19 medical bills too costly for NHIF

The National Health Insurance Fund (NHIF) would have spent between Sh5 billion and Sh23 billion on Covid-19 treatment for insured beneficiaries in the best and worst case scenarios.

The estimate, according to a presentation made yesterday by NHIF Chief Executive Officer Peter Kamunyo, was based on treatment costs inclusive of personal protective equipment (PPE) as outlined on a Kenya Medical Research Institute-Wellcome Trust policy brief.

Dr Kamunyo said the amount d represents 45 per cent of NHIF’s total annual collections. In a second case scenario, based on current fund reimbursement costs for general care and reported market costs for critical care excluding PPEs, NHIF would have spent between Sh1.17 billion and Sh5.44 billion. Appearing before the Senate Health Committee to shed light on why the NHIF, a public insurer, could not foot Covid-19 medical bills, Dr Kamunyo said all the scenarios presented a significant cost burden to the agency.

In May, Dr Kamunyo announced that the fund would cover Covid-19-related admissions in designated public health facilities including the Kenyatta National Hospital, the Kenyatta University Teaching, Referral and Research Hospital, Mbagathi County Hospital, county-designated facilities and any other facility as may be designated by the Ministry of Health.

Spread virus

“In support of the government's efforts to curb the spread of the virus, we shall support all Covid-19 positive members and their declared beneficiaries who get admitted to MoH-designated facilities,” Dr Kamunyo had said.

What changed? This is one of the questions to which the legislators were demanding answers.

Led by the committee’s chairman Michael Mbito, the senators demanded to know why Kenyans are continuing to remit money to the NHIF yet they cannot access services when need arises.

“Why is it necessary for a mama mboga to be remitting Sh500 every month but has to pay hospital bills out of pocket? We need answers,” said Narok Senator Ledama Olekina. Kericho Senator Aaron Cheruiyot demanded to know how much money the NHIF needs to be able to meet the treatment cost.

Supplementary budget

“Almost 90 per cent of Kenyans are insured by NHIF and they would need the services. Not paying for Covid-19 treatment is not an option. A supplementary budget should be sent to the committee for approval so that they are able to meet the treatment costs,” he said.

Read: Managing Covid-19 patients in ICU costs Sh71K a day, says Amoth

Health Cabinet Secretary Mutahi Kagwe told the committee on Wednesday that the NHIF would not foot Covid-19 medical bills for insured Kenyans. Initially, the government had promised to foot the bills for those placed in quarantine and isolation centres.

However, most public hospitals have been secretly slapping patients with huge medical bills following delays by the government to remit money to the NHIF.

An uninsured Covid-19 patient who ends up in the intensive care unit is likely to pay Sh71,000 per day. Insurers agreed to cover Covid-19 after consulting their regulator. Acting Health Director-General Patrick Amoth last Friday said that the daily treatment costs of an asymptomatic patient averages Sh21,000 and Sh21,400 for one with mild symptoms.

Those with severe Covid-19 requiring supplemental oxygen pay Sh51,000 while critically ill patients who need ICU or ventilators pay an average of Sh71,000. About 90 per cent of Kenyan cases are asymptomatic. 

One can only be declared virus-free after two weeks. It, therefore, means treatment costs for the 14 days ranges from Sh298,000 to Sh300,000.

Dr Amoth said most of the cost goes to protective gear used by medical staff, with a full PPE kit going for Sh10,000 and is used for a single session per patient. This means a doctor discards the gear every time he or she leaves a patient after a visit. Due to the special care required, a doctor could visit the patient even three times a day.

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