NHIF will stop paying for treatment of chronic diseases such as cancer, diabetes, heart and kidney ailments in private hospitals once parliament approves changes aimed at reducing payouts.
Fresh regulations published by the State-backed insurer require it to cover patients with chronic illnesses in government hospitals like the overburdened Kenyatta National Hospital in Nairobi.
“A beneficiary with chronic illness shall access treatment for chronic illness from public health care providers only,” says the new regulations that were published Wednesday for public review pending approval by MPs.
This sets up low-income patients and affected households for tough times given the majority of them rely on the NHIF for diagnosis, drugs and hospital expenses.
The radical move will also hurt private hospitals like Nairobi Hospital, Nairobi West and Mater that receive billions of shillings to provide care to patients with chronic illnesses.
Reduced budgetary allocations and mismanagement by county governments have seen public hospitals struggle to treat chronic ailments due to lack of equipment and doctors.
In October 6 last year, Health CAS Mercy Mwangangi said private facilities were the main culprits in this malpractice.
“We have seen complaints of patients who go to hospital and come out with a draft sheet of procedures to be done,” she said.
“What we are doing is coming up with a system of pay that bundles the tests. For example, if a patient is being treated with diabetes, NHIF will know the tests that will be required for that.”
The proposed regulations are aimed to push private health insurers to pay their fair share of medical costs.