NHIF medical cover details

The National Health Insurance Fund (NHIF) has revealed that payments for renal dialysis have more than tripled in the last four years.

NHIF reportedly paid Sh3.844 billion for 295,563 claims for patients who sought renal dialysis in the year to June 2021.

This represented a 208 percent jump from Sh1.247 billion the NHIF paid for dialysis in the year to June 2017.

NHIF members are entitled to two weekly sessions of dialysis with each costing Sh9,500, pushing the total annual payment per patient to an average of Sh960,000.

NHIF Announces Cost-Cutting Plan

Last month the national medical insurer announced a 3billion cost-cutting drive, aimed at reducing payouts to hospitals by at least Sh2.9 billion in the year to June 2022.

Renal dialysis, major surgeries and diagnostics tests such as MRI and CT scans are top on the list of benefits that the National Hospital Insurance Fund aims to cut in the effort to reduce payouts.

NHIF is seeking to reduce bills for dialysis by Sh1 billion annually. In the proposed changes, the average payout for renal dialysis will be capped at Sh6,000 down from the current Sh9,500.

The maximum cover for MRI scans will be reduced to Sh9,600 from the current Sh15,000 per session while settlement of CT scans is set to be capped at Sh6,000 from Sh8,000.

NHIF’s total payouts more than doubled in five years from Sh19.7 billion in the year to June 2016. It paid out Sh54.6 billion or 88.7 percent as claims to hospitals in the year ended June 2021.

NHIF chief executive Peter Kamunyo attributed the issue to a significant number of patients with chronic illness, who are joining the fund after falling ill.

“We have patients paying Sh6,000 annually and receiving benefits of nearly Sh1 million per year. This is a burden to NHIF,” Dr Kamunyo said.