The National Health Insurance Fund( NHIF) will allow members to directly pierce adviser croakers and private apothecaries in a move aimed at widening treatment options and keeping a lid on costs.
NHIF principal superintendent Peter Kamunyo said the board is presently finalising roll- eschewal of the model that will offer members more options in penetrating healthcare and reduce quantities spent on payment for claims.
Presently, NHIF pays for services through accredited hospitals, locking out advisers operating in private conventions and apothecaries.
This has forced its members to meet the cost of buying drugs and tapping consulting croakers outside good hospitals.
“ Right now, we can only repay hospitals and that has been a problem. The( NHIF) platoon is working veritably hard to insure we get there because this is one of the big- ticket particulars( demanded) to achieve quality and cost constraint. ”
The shift is riding on changes to the NHIF( Correction) Act, 2022 that now allow the State insurer to directly contract individual healthcare professionals to give consultancy, preventative care and other services.
The former law confined the NHIF to public, private and faith- grounded hospitals for outpatient and inpatient services.
Now, the NHIF will negotiate the payment rates with private conventions and apothecaries as it races to borrow the business model pursued by insurance enterprises. The fund didn’t give details of how its members will pierce the planned service.
Sanctioned data shows that Kenya had 13, 376 registered croakers and,285 registered druggists as at December last time. The NHIF is laying on its wide class of13.8 million to negotiate freights lower than the request rates.
The State- backed insurer spent Sh54 billion on claims in the time ended June 2021, representing 91 percent of the Sh62 billion it collected as decorations.
“ presently, the motorists of costs in the health sector are drug and diagnostics, ” the NHIF says in a detail.
It estimates that medicines regard for between 30- 70 percent of the treatment costs, italicizing the need to seek blinked prices and freights from consulting croakers.
Dr Kamunyo added that the deals with druggists and medicine manufacturers will be an enhanced interpretation of a contract that the NHIF inked with Janssen Kenya – a company possessed by American medicinal mammoth, Johnson & Johnson.
The NHIF’s deal with Janssen Kenya allows prostate cancer cases to get 10 packs of Abiraterone acetate — a tradition medicine — at Sh600,000 which is half the request price of Sh1.2 million.
“ We’ve negotiated with crucial pharmaceutical companies and we’re going on and this will be more enhanced when we start a drugstore benefits operation, ” Dr Kamunyo said.
The State- backed insurer is keen to contain costs and cover cash reserves given its part of leading affordable and quality healthcare to all Kenyans under universal health content( UHC).
The NHIF is at the centre of the government’s ambitious UHC where all class is mandatory to all Kenyans progressed 18 times and over. The State insurer is also battling high rates of fictitious claims and adverse selection that bleed it up to Sh16.5 billion annually, piling pressure on its finances given that it spends over 90 percent of its decorations to settle claims.
The scheme has also increased payment rates to contracted health installations by 12 percent, further than doubled the number of surgical procedures it covers and expanded oncology benefits for cancer cases, bringing to fore the significance of containing costs.
