Doctors and insurers clash on reduction of medical fees

The health sector in the country is set for choppy waters after insurance companies and doctors failed to agree on the proposed reduction of medical fees.

Insurance companies that provide healthcare cover have threatened to increase the premiums if the fees charged by doctors in medical institutions were not revised.

A premium is the regular installments for an insurance policy by an individual or an organization. Once paid the insurance is mandated to provide coverage to the people.

According to the insurers, the sector is bleeding from the high cost of healthcare coverage which can be afforded by only three percent of Kenyans outside the National Hospital Insurance Fund (NHIF).

A report by the Association of Kenya Insurer says that out of 37 insurance companies only 19 provide medical cover in the country with the number of people buying the indemnity reducing.

“We might soon have to increase our rates of medical covers as the doctor fees in its current form will put the insurance out of reach for many Kenyans,” said Ms Jemimah Mbugua of Resolution Insurance.

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The insurance industry is reported to record the first decline since 2013 with about Sh38.4 billion premium covers bought in 2017 compared to Sh38.8 billion in 2016.

“Why are doctors separating medical fees whenever they perform a double surgery on the same patient at the same time? We are making losses due to the unreasonably high bills,” said Ms Mbugua.

Yesterday, the Consumer Federation of Kenya (Cofek) organized a public consultation on the mater but the doctors declined to attend the meeting despite presence from the Kenya Medical Practitioners and Dentists’ Board (KMPDU).

This is due to the fact that the doctors are opposing the review of medical fees as proposed by the insurer and some members of the parliament.

The National Assembly last year requested the board to review the doctor’s fees gazetted in the 2016 professional fees guideline as the government has the authority to set fees in public hospitals.

However, the doctors have argued that the minimum doctor’s fees should not be slashed rather they should reduce the maximum fees by 20 percent.

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Changing the doctor’s minimum fee, which comprises 10-20 percent of the total hospital charges, will affect the benefit they are currently enjoying.

The Cabinet Secretary of Health Sicily Kariuki is set to hear the proposal from the medics this Friday.