Nairobi staff to use NHIF only in public hospitals

A member of the public scans his finger during NHIF mass biometric registration in Nyeri County on June 2, 2021. FILE PHOTO | NMG

By COLLINS OMULO
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Summary

• At the same time, the policy will obligate all employers of casuals in Nairobi to pay for their National Hospital Insurance Fund (NHIF) medical cover.
• NMS director of health services Ouma Oluga said they are engaging NHIF on the proposal.
• He said the NHIF spends Sh14 billion annually on medical claims in Nairobi alone.

All individuals on the national insurance scheme in Nairobi will soon be required to only use the cover in public hospitals, once a new policy being prepared by the Nairobi Metropolitan Services (NMS) is enacted into law.

At the same time, the policy will obligate all employers of casuals in Nairobi to pay for their National Hospital Insurance Fund (NHIF) medical cover.

NMS director of health services Ouma Oluga said they are engaging NHIF on the proposal, arguing that there is no way the government would spend billions in covering its employees but those who benefit are private institutions.

He said the NHIF spends Sh14 billion annually on medical claims in Nairobi alone. However, the bulk of the money, at Sh11 billion goes to the private hospitals, Sh2 billion to Kenyatta National Hospital and Sh1 billion to faith-based hospitals.

However, once the policy becomes law, individuals on the national insurance scheme in Nairobi will have public hospitals as their first point of call unless there is a valid reason for one to opt for a private one.

“We can’t be implementing this (policy) then someone else is enjoying the money. You can see the government is getting nothing from NHIF,” said Dr Oluga, adding that NMS director-general Mohamed Badi has given a go-ahead for the formulation of the policy, which is at the drafting stage.

“There are four stages of coming up with a policy which involves formulation stage to come up with a draft then taking the draft through legislative process, public participation then validation and then enact it as an Act. We are still in the formulation stage but the entire process could take six months,” he said.

He cited NMS staff who opt for private hospitals, incurring up to Sh800,000 in bills yet the NHIF limit is Sh700,000, forcing them to engage the insurer to pay the extra amount.

“If this employee was to go to our hospital, like the Highridge Hospital, instead of the Sh800,000 one will part with Sh50,000. Why should one then go for costly services in private hospitals yet we can provide the same service at almost 20 percent the cost?”