The National Hospital Insurance Fund will no longer accredit health facilities, under new reforms aimed at delivering Universal Health Coverage (UHC) by 2022.
In the changes, the Health ministry and the Medical Practitioners and Dentists Board will be the accrediting agencies.
“NHIF will move away from issues that are peripheral to it. The Ministry of Health and the board will carry out the work,” Health Cabinet Secretary Sicily Kariuki said.
She said after accreditation, hospitals will be gazetted and the insurance provider will pick it up from there.
UHC is expected to herald the transformation of the country’s health sector, which has been marked by inequalities because of poverty and low uptake of medical insurance.
President Uhuru Kenyatta launched the initiative on December 13 last year.
He ordered that NHIF and the Kenya Medical Supplies Authority be reformed.
Currently, NHIF is responsible for accrediting and reimbursing hospitals.
But there have been a lot of complaints that hospitals are colluding with the insurer to generate false medical bills for people who have not sought treatment. The Directorate of Criminal Investigations (DCI) is looking into how NHIF officials pocketed up to Sh12 billion from beneficiaries who had not sought medical treatment from any hospital.
Investigations revealed rogue NHIF officials might have colluded with hospitals to generate the false claims.
Detectives had obtained a court order requiring the hospitals to produce books of accounts, invoices and claims for payment by NHIF from 2013 to date.
When they take over, the Health ministry and the medical board will monitor payments to hospitals, assess the quality of services Kenyans are getting and the competencies of the facilities.
Ms Kariuki said that with the reforms, every shilling spent by the insurer will cover two or three people.
“NHIF covers up to 20 per cent of the population today, yet the rates members are charged in any hospital is the same as in any private insurer covering one per cent of the population.
The advantage gets lost because NHIF should play with its strength of economies of scale. This is what insurance funds in other countries where UHC is a determined journey are able to do,” Ms Kariuki said.
The new changes will make NHIF negotiate for quality service.
“It will not just be about walking in and out of any hospital. NHIF will be concerned with the quality of care, what amount of time patients take in a hospital and efficiency of the treatment. We are moving to patient-centric care by the insurance service provider. They are not just in the commercial space as it were,” she said.
Ms Kariuki added: “The Ministry of Health and indeed all Kenyans envision a more efficient, socially accountable and transparent NHIF.
The NHIF reforms will be closely monitored, coordinated and driven concurrently with other key and ongoing service delivery-oriented reforms in the health sector.”
The agency will also be in charge of strengthening pharmaceutical practices and regulatory systems.
Ms Kariuki was speaking on Tuesday during the inauguration of an expert panel to transform and reposition NHIF.
The independent panel of experts with 17 members will be required to develop an action plan that will see the transformation of NHIF into a strategic purchaser of health services.
“They will focus on financial sustainability, which will include the analysis of the sustainability of NHIF under different financial and service coverage scenarios,” Ms Kariuki said.
They will also strengthen the financial and social accountability of the health insurer.
The panel is expected to produce its report within 90 days.
By Daily Nation