The National Hospital Insurance Fund (NHIF) is set to reduce the amount it pays for covered patients by a whopping Ksh2.9 billion as part of the cost reduction proposals.
If the changes are approved, NHIF would reduce the payout to hospitals by almost 30 percent and force thousands of covered patients to top up their medical bills.
Among the changes stipulated include reduction of (MRI) Magnetic resonance imaging scans from Ksh15,000 to Ksh9,600, (CT) computerized tomography scans would reduce from Ksh8,000 to Ksh6,000.
Further, renal dialysis cover would reduce from Ksh9,500 to Ksh6,000. The cover for cancer patients would, however, rise. Positron emission tomography (PET) scans would increase from Ksh32,320 to Ksh40,000, while basic chemotherapy would increase from Ksh17,062 to Ksh25,000.
The proposed changes have ruffled doctors' feathers as they fear that the majority of patients would succumb as they would be unable to cater for the services.
Kenya Renal Association stated that NHIF ought to have consulted various stakeholders before instituting the proposed changes.
"I'm worried as to what is going to happen to our patients. For instance, five years ago, the number of patients undergoing hemodialysis in this country was less than 500. The reason for this is out-of-pocket expenditure for this is unachievable," a nephrologist spoke to the media.
NHIF CEO Peter Kamunyo addressed the concerns, affirming that the proposed changes were still in their early stages and would undergo consultations before the final cover plan was implemented.
"The aim for us is not to reduce benefits, in fact, what we want to achieve is that our members have the benefits without spending and that is why the contracts that we are having will be two; comprehensive and non-comprehensive," Kamunyo stated.
For the comprehensive cover, members would be entitled to receive services as per the agreed benefit package without any co-payment except for surgical cases that end in theatre operations.
In the case of non-comprehensive, a member would be entitled to receive all the services as per the agreed benefit package; however, the insurance fund would only pay for the agreed daily amount with the member making a co-payment of the difference.
The new changes are part of the bid to ramp up the registration drive that would see the majority of Kenyans access services delivered by the fund.
