Why Your Preferred Hospital Could Soon Decline NHIF

At least 660 hospitals in Kenya may walk away from the National Health Insurance Fund (NHIF) over a raft of complaints. The facilities under the Kenya Faith Based Health Services Consortium (KFBHSC) and Rural Private Hospitals Association (RUPHA) noted that they were mulling withdrawing outpatient services for NHIF members over incongruent capitation rates.

Under the RUPHA umbrella are 367 healthcare facilities in rural and urban underserved populations including Nairobi’s Kangemi and Kayole as well as Kisauni in Mombasa.

The hospitals questioned why they were being asked by NHIF to quote Ksh1,000 per year per beneficiary in their invoices instead of the agreed upon Ksh1,400.

“We are in a state of limbo as to whether we should serve NHIF outpatient or not because we run the risk of not being paid adequately,” stated Dr Samuel Mwenda who chairs the Kenya Faith Based Health Services Consortium (KFBHSC).

Capitation is paid to health facilities in advance. It is calculated based on the number of NHIF members assigned to a particular health facility.

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“We are in the second month of the quarter and health facilities have not received their capitation resulting to inordinate inconveniences,” disclosed RUPHA chairman Dr Brian Lishenga.

The groups further raised issues with delays in the distribution of physical contracts for the 2022-2024 cycle, claiming that it could affect the delivery of services.

KFBHSC and RUPHA gave the NHIF up to Wednesday, August 31 and Thursday, September 1 respectively to respond to their demands failure to which health services would be affected across the country.

They explained that NHIF branch offices were asking health facilities to share invoices using the rate of Ksh250 per beneficiary per quarter, equivalent to Ksh1,000 per beneficiary per year. The capitation amount payable to level four and five hospitals, however, is Ksh350 per beneficiary per quarter or Ksh1400 per beneficiary per year.

The hospitals piled pressure on NHIF to address the matters urgently to ensure the continued provision of health services to its members.

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