Kenyans who wish to receive medical treatment outside of Kenya must meet five strict requirements before their treatment can be covered by the National Health Insurance Fund (NHIF) in reforms being championed by President William Ruto.
In the proposed NHIF Regulations 2023 outlined to ensure a more streamlined and effective process for health coverage, beneficiaries need to have cleared their contributions and arrears before being authorised to travel abroad. They must also provide the national insurer with a referral letter from their doctor.
Some of the details referring doctors are required to provide include; the nature of the disease, the duration the doctor had treated the patient, treatment or procedure for which the patient is being referred, among others.
The doctor must also indicate whether the treatment is available in Kenya and why it is sought abroad.
"If yes, state why the treatment, procedure or investigation outside the country is necessary and essential to the prognosis of patient’s condition." read the form in part.
Patients will also be required to obtain a letter of no objection from the Director General for Health, a position currently being held in an acting capacity by Patrick Amoth.
"The Board shall consider the request for authorisation of treatment outside Kenya to verify that the health service requested for authorization is unavailable in Kenya.
"Where the Board is satisfied that the health care service is not available for the beneficiary, the Board shall authorise the treatment of the beneficiary outside Kenya," reads the regulations in part.
Most Kenyans usually go to other countries for specialised treatment for cancer and heart-related diseases.
Some of the countries Kenyans seek medical refuge include India, Israel and the United Kingdom.
Significantly, in the proposals, Kenyans with chronic diseases will get unlimited coverage even if they deplete their limit. However, they will have to complete all their areas and contributions.
Contributions
It is proposed for employed and self-employed Kenyans to pay 2.75 per cent of their salaries or income monthly.
Some unemployed Kenyans will pay Ksh1,000 monthly in the government's latest proposals.
"The amount payable by the National Government on behalf of indigent and vulnerable persons shall be Ksh13,300," NHIF proposed.
Government's Stand
Ruto has championed reforms underlining its benefits to many Kenyans struggling to make ends meet while criticizing he current payment model, which he argued was unfair and unbalanced.
"It does not make sense that the president pays Ksh1,700 every month and the common citizen pays Ksh600 to have NHIF. My salary is Ksh1 million and the bodaboda earns Ksh700," Ruto expressed then.
However, despite Ruto's optimism, a number of health experts expressed their reservations over the proposals.
Expert Opinion
Speaking to Kenyans.co.ke at a past interview, Health Financing Expert with 10 years of experience, Edward Owino, opined that the government needed to champion voluntary contributions and revamp public hospitals first.
Owino explained that a number of employees had other private health insurance schemes and rarely use NHIF, given the difference in services offered.
"Why would the government force you to pay more? You find that someone will part way with Ksh25,000 yearly, yet they will not even use NHIF," Owino explained.
