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Uproar over NHIF plan to cut cash for dialysis

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Uproar over NHIF plan to cut cash for dialysis


The National Hospital Insurance Fund (NHIF) in this picture taken on Tuesday, October 26, 2021. PHOTO | DENNIS ONSONGO | NMG

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Summary

  • The State-backed insurer has proposed to chop the average payout for a renal dialysis session to Sh6,000 from the current Sh9,500.
  • Apart from cutting renal dialysis payouts to hospitals, the NHIF intends to slash expenses on major surgeries and diagnostics tests such as MRI and CT scans.
  • Benefits for cancer patients are to be increased as the country battles rising cases of the deadly disease.

Kidney patients have faulted plans by the National Hospital Insurance Fund (NHIF) to slash payouts for renal dialysis as part of a cost-cutting drive, warning it would put thousands of lives at risk.

The State-backed insurer has proposed to chop the average payout for a renal dialysis session to Sh6,000 from the current Sh9,500 as it seeks to reduce bills for the weekly procedure by Sh1 billion annually to Sh2.7 billion.

But the Renal Society of Kenya, a lobby for kidney patients, termed the plans alarming and urged the insurer to rethink its decision.

“These changes do not result in any dialysis cost-saving for NHIF and we are at a loss as to what gain they are being effected,” the association’s founding president, John Gikonyo, said in a statement.

“There has been no consultation with patients, kidney doctors, and dialysis service providers in the country, who are all of the opinions that the cost reduction will disrupt and destabilise this life-saving service and that this may result in many patients paying with their lives.”

They said the Sh6,500 payouts would be insufficient even in low-cost public hospitals.

“For the avoidance of doubt, we kidney patients have not asked for a third dialysis session, and would rather not have it if it comes at a cost to us, or at the risk of compromised dialysis services or worse no, dialysis at all,” the association said.

Apart from cutting renal dialysis payouts to hospitals, the NHIF intends to slash expenses on major surgeries and diagnostics tests such as MRI and CT scans.

The insurer says the cost-cutting drive, which will force thousands of beneficiaries to top-up for their medical bills, will save it at least Sh2.9 billion in the year to June 2022.

According to the NHIF plan, the maximum cover for MRI scans will be reduced to Sh9,600 from the current Sh15,000 per session while settlement of CT scans is set to be capped at Sh6,000 from Sh8,000.

But benefits for cancer patients are to be increased as the country battles rising cases of the deadly disease.

The average payment for PET scans — used to diagnose ailments like cancer — will increase to Sh40,000 from Sh32,320 while that for basic chemotherapy will be increased to Sh25,000 from the current Sh17,062.

Payouts for complex chemotherapy will be capped at Sh100,000 from Sh72,852, with the average radiotherapy claim set at Sh72,000 from the current Sh61,224. The review of benefits comes as the NHIF faces mounting claims from hospitals. The payouts more than doubled in five years from Sh19.7 billion in the year to June 2016.

It paid out Sh54.6 billion or 88.7 percent as claims to hospitals in the year ended June 2021.

NHIF chief executive Peter Kamunyo in the past claimed that a significant number of patients with chronic illness were joining the fund after falling ill.

“We have patients paying Sh6,000 annually and receiving benefits of nearly Sh1 million per year. This is a burden to NHIF,” he told the Business Daily.

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