NAIROBI, Kenya, Apr 2 – A new scheme by the National Hospital Insurance Fund (NHIF) is set to streamline access to healthcare as it will now require patients to first seek treatment from out-patient clinics before they seek specialised care in tertiary institutions like District Hospitals.
Medical Services Minister Anyang’ Nyong’o says that such a referral system will decrease the number of people seeking inpatient services and reduce fraud at NHIF.
“Since the establishment of NHIF in 1966, it has just been providing inpatient care which led to massive fraud in the 1980’s and 90’s. As soon as you go to see some doctors, they would admit you because that is when they know that NHIF will pay them some money,” Nyong’o said in an interview with Capital FM News.
But with the provision of out-patient services, he said this will reduce drastically as had been seen with the civil servants scheme.
Nyong’o explained that the previous scheme saw many patients admitted to hospital when they did not need to, while other facilities extended admission longer than it was necessary.
“By covering out-patient care, and promoting many places (health facilities) where people can go and seek out-patient care, the number of in-patients has dropped drastically which means it reduces costs because inpatient is more expensive,” the minister said adding that this was also a way of decongesting tertiary health institutions like Kenyatta National Hospital.
In a previous interview with Capital FM News, NHIF Manager in charge of Planning and Strategy Chacha Marwa insisted a referral system had to be followed in the new scheme that is to offer both out-patient and in-patient services.
“Any in-patient case, unless it is an emergency, will have to have gone through a sieving process that starts from the lowest facility to the tertiary facility. We are not going to encourage people to just walk from home and go to the highest level of care,” Marwa had said.
Nyong’o on the other hand said for the system to work, NHIF needed to provide equipment like diagnostic machines to its accredited health facilities that did not have.
“It is in NHIF’s interest to invest in this because people are paying money to NHIF for insurance. In return they should get services; if they don’t get the services, it is the person who receives the insurance money whom they will blame,” the minister said.
“What NHIF will do is… every month they reimburse a hospital for the services delivered. NHIF cannot be giving you (hospital) rebates and you don’t have the facilities to serve the people. So what we are going to do is buy for you the equipment and then you will pay back over a period of time without interest so that the hospital will manage to get equipment outside the commercial circuit,” he explained.
He added that the ministry was currently equipping dispensaries and health centres to ensure a proper referral system.
“This used to happen in colonial times very efficiently but somehow along the line it broke down,” Nyong’o said in the interview.
He also said that a decongestion programme was currently being done at Kenyatta National Hospital, the largest referral facility in the country, where they were working to establish satellites across the country.
“It takes time but they have already started,” he stated.
However, the minister said, in the meantime, the health centres and dispensaries across the country would provide primary health care as they were.
On the issue of unregistered indigents, he said the government would from the next financial year allocate at least Sh1.5 billion per month to cover the poor.
“You can’t put in the constitution that everybody has a right to access affordable and quality health care and then not provide for it. That is why we are working very hard to get NHIF going because it will help government implement that provision,” he said.