Oct 19, 2021

Mawazo Writing Africa

Writing about the main

Covid-19 patients stranded after NHIF refuses to pay

Peter Kamunyo, Chief Executive Officer of the National Health Insurance Fund (NHIF), told members while appearing before the Senate Health Committee that the fund was p259 million> Dr. Kamunyo said the fund could not cover the costs related to Covid-19 management for current members of the national or extended medical system Members for the pandemic coupled with the fact that the risk exposure from Covid-19 cannot be accurately determined, NHIF was unable to cover the costs related to Covid-19 management for the remaining members, “he said .

However, he said that according to President Uhuru Kenyatta’s direction, frontline workers from the National Police Service, Kenya Prisons Service, officials and staff from the National Youth Service are insured for serious illnesses, among others, including Covid-19 -Treatment.

He said the NHIF had not received funding from the national government to cover Kenyans for Covid-19.

In the best and worst cases the fund will Spend between Sh 1 billion and Sh 10 billion on Covid-19 treatment for insured beneficiaries.

For a cohort of 595 Covid-19 recordings processed by the fund between July 2020 and June 2021 , the average cost of a Covid -19 intake is 603,130 (average cost per recording day 82,584), compared to 62,222 for daily allowance reimbursement and 241,468 for standard market reimbursement.

This would be projected to Sh 11 billion Use. Of the projections, the fund would need at least Sh1 billion to cover the population for the next six months. For this, 74% would have to be paid out of pocket to cover the administrative costs.

According to the National Statistics Office of Kenya, the number of members of the fund rose by six percent last year to 22 million in 2019/20 and as a result the contributions rose by 5.7 per cent to 59.5 billion Shillings, while the amount of the benefit payments rose by 1.8 per cent to 54.4 billion Shillings. rise.

NHIF membership in the formal sector of the economy is up 3.6 percent, compared to 8.3 percent growth in the informal sector.

Supa Cover, Kenya’s largest and cheapest health insurance, costs 500 Sh members and beneficiaries a month for the client.

The fund’s decision has left many Kenyans who depend on it to pay for treatment stranded and Covid -19 bills cannot pay. It also raises the question of why the fund exists if it can’t cover bed costs for the poor.

With Kenya predicting another wave in the next two weeks, thousands of people across the country are likely to be infected and may need to be hospitalized. Many of them will get into trouble as a result.

The cost of Covid-19 treatment varies greatly depending on the severity of the disease and the hospital.

According to a model from the Kenya Medical Research Institute ( Kemri), the cost of Covid-19 case management per patient in hospitals ranges from Sh21,000 per day for asymptomatic patients and those with mild symptoms, Sh24,705 for patients with severe illness to Sh51,684 for critical patients in intensive care units.

According to Kemri’s estimates, a patient with severe symptoms who was isolated for a week would have to pay more than 350,000 Shillings in hospital bills, or 750,000 Shillings if in intensive care.

Previously, NHIF Chairman Lewis Nguyai had indicated that it is not possible to pay for Covid-19 as those with Supa coverage only pay Sh500 but claims are running at Sh8 million.

“Share Sh8 million and see how many F amilies who pay Sh500 have robbed the fund. Statistically, this is currently not achievable. We are working on modalities to see how we can cover them, although we also don’t understand the risk, ”said Mr. Nguyai.

Last year the NHIF announced in a circular that they only pay discounts on treatment bills incurred by accredited Covid-19 patients at Kenyatta National Hospital, Kenyatta University Teaching and Referral Hospital, Mbagathi Hospital, and other health department designated hospitals in the counties. It states that treatment in private hospitals is not covered.

“We will support all Covid-19 positive members and their declared beneficiaries who will be admitted to the facilities designated by the Ministry of Health. NHIF is not liable for bills that are incurred in health facilities not named by the MoH, ”said Dr. Kamunyo in the circular.

An uninsured Covid-19 patient ending up in intensive care is likely to pay Sh71,000 per day. The average daily treatment cost for an asymptomatic patient is Sh21,000 and Sh21,400 for one with mild symptoms.

Those with severe Covid-19 who need supplemental oxygen pay Sh51,000, while critically ill patients who need an intensive care unit or ventilators pay an average of Sh71,000. About 90 percent of Kenyan cases are asymptomatic.

One can only be declared virus-free after two weeks. This means that the cost of treatment for the 14 days is 300,000 Sh.

Most of the cost is related to the protective equipment used by medical staff, using a full PPE kit for Sh 10,000 a session per patient. Due to the special care required, a doctor could visit the patient up to three times a day.