Kenya’s national health insurer (NHIF) captured by cartels, World Bank/Kemri report

A World Bank/KEMRI team reports NHIF has been captured by powerful private hospital groups and turned into a scheme for the better off at the expense of the poorest.

Consequently 73 per cent of the informal sector contributors to NHIF, the team says did not renew their membership last year.

The team shows some hospitals encourage higher capitated NHIF members such as civil servants to jump informal workers on the queue.

These hospitals also send NHIF members from the informal sector to buy medicines outside the facilities while keeping the drugs for civil servants.

Some hospitals, the report says have set up, staffed, and equipped special civil servants clinics while the poor NHIF members are attended to in poorly resourced areas.

In a new report, the team says although NHIF had been reformed to handle expanded universal health care, it is not yet up to the task.

In summary, the study published on September 24th 2018 in the journal Health Systems and Reform says NHIF is suffering; ‘purchaser capture,’ inefficiency, fraud and leakage and low resource mobilization.

The study was led by Dr Edwine Barasa, a health economist and the director of the KEMRI-Wellcome Trust Nairobi programme.

Dr Barasa is also among a team of 16 experts recently appointed by the Ministry of Health to prepare a Universal Health Coverage Essential Benefits Package.

From the World Bank are Prof Kama Rogo, head of the World Bank Group’s Health in Africa Initiative and Dr Njeri Mwaura and Jane Chuma.  “The views expressed in this paper are from the authors and do not reflect those of the World Bank,” they however put a disclaimer.

The team presents evidence, showing the current NHIF scheme is deliberately skewed to favour the already better off formal workers and civil servants at the expense of the poor informal contributors and those subsidized by the government.

But more notable, the report suggests NHIF is unfairly benefiting private health facilities participating in the scheme.

Private health care providers, a powerful interest group in Kenya, are strongly represented in the NHIF management board by professional associations.

“Their influence on the NHIF with regard to reimbursement rates represents “purchaser capture,” a situation where the actions of a purchaser are influenced by, and in favour of, healthcare providers,” says the report.

Some health care providers are accused of enrolling patients into expensive but unnecessary procedures primarily to claim reimbursements from NHIF.

It is to be remembered that efforts to introduce free health care in Kenya during former President Mwai Kibaki’s regime were frustrated by the same groups.

The Kemri/WorldBank team reports that up to 65 per cent of ‘poor’ Kenyans currently benefiting from a government subsidy to NHIF are actually ‘fakes’.

“Data analysis shows that 65 per cent of the beneficiaries are in the richest two quintiles.”

The report also accuses NHIF of weak accountability mechanisms which have led to an increase of fraud by its staff as well as healthcare providers.

As constituted, the experts say NHIF cannot deliver universal health care and recommend drastic changes.

Most important they say is to discard a contributory health scheme for one which is fully paid for by the government through efficiently collected and utilized taxes.

“Kenya will not be able to mobilize sufficient resources using a voluntary contributory mechanism.”

Kemri researchers in collaboration with the University of Oxford have been consistent that a contributory health insurance scheme will not work in Kenya.

Full report here:

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4 thoughts on “Kenya’s national health insurer (NHIF) captured by cartels, World Bank/Kemri report

  • October 9, 2018 at 6:32 pm

    nothing positive from the study? surely? aaiiiii the data looked skewed to a certain opinion!!!!

  • October 10, 2018 at 6:22 pm

    NHIF has saved lives. The report is flawed. Surely, when will Kenyans learn to appreciate and conduct clean research. I feel dissapointed..

  • October 11, 2018 at 6:10 am

    I fully agree with the findings!!! Having fallen victim and witnessed first hand how a provider discriminates against self covered contributors preferring instead to attend to civil servants. On the same breadth two months ago one of my aunts came to Nairobi to seek treatment. Unfortunately when she went to the hospital they rescheduled her treatment for November. She went back home/ up country and to our disbelief in between she visited a subcounty hospital in KISUMU only to be told that according to the system it indicates that she is admitted at the hospital in Nairobi….I followed up and all were indifferent to the anomaly this is both hospital and NHIF staff

  • October 11, 2018 at 2:35 pm

    Surely, what of the insurers who demand NHIF pays first.
    Skewed report.

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