In an effort to increase treatment options and control expenses, the National Health Insurance Fund (NHIF) will now permit members to directly access consultant doctors and private pharmacies.
Peter Kamunyo, the chief executive of the NHIF, said the board is presently finalizing the model’s roll-out, which will provide members additional options for receiving healthcare and cut down on the amount spent on paying claims.
NHIF only pays for services provided by authorized hospitals at the moment, which excludes consultants working in private clinics and pharmacies.
Due to this, its members are now responsible for paying for the expense of purchasing medications and contacting doctors outside of accredited facilities.
“Right now, we can only reimburse hospitals and that has been a problem. Why don’t we have consultants who charge less, we can negotiate with them because the Act was that we could only reimburse hospitals,” Dr Kamunyo said on Monday.
“Now we will be more creative in cost containment, adding quality and value to our members. The [NHIF] team is working very hard to ensure we get there because this is one of the big-ticket items [needed] to achieve quality and cost containment.”
The shift hinges on amendments to the NHIF (Amendment) Act, 2022, which now permit the State insurer to directly hire healthcare professionals to provide consultancy, preventive care, and other services.
The NHIF was only available for inpatient and outpatient care at public, private, and faith-based hospitals under the prior statute.
In an effort to imitate the commercial strategy used by insurance companies, the NHIF will now bargain the payment rates with private pharmacies and clinics.
The fund did not go into specifics on how its members will use the anticipated service.
According to official statistics, as of December of the previous year, Kenya had 13, 376 registered doctors and 4,285 registered pharmacists.