As a result of an imbalance in capitation rates and delays in contract signing, over 660 hospitals intend to stop providing outpatient treatments to NHIF members.
As opposed to the agreed-upon Sh1,400 per beneficiary each year, the facilities run by faith-based organizations and the Rural Private Hospitals Association (RUPHA) claim that NHIF branch offices are requesting invoices with Sh1,000 figure. The healthcare providers also point out that the insurance has not yet sent out physical contracts for the cycle 2022–2024, which could put them in danger of legal troubles.
All eligible members from the formal and unofficial sectors are registered with NHIF. The requirement to join applies to people working in the official sector. Membership is free and available to pensioners and persons in the unorganized sector.
Dr. Samuel Mwenda, the chairman of the Kenya Faith Based Health Services Consortium (KFBHSC) said that they are unsure of whether they should provide outpatient care for NHIF because they face the risk of receiving inadequate compensation.
The NHIF has been given until tomorrow to resolve the consortium’s and RUPHA’s concerns; else, they warn, that health services will suffer. According to the NHIF and healthcare providers’ soft copy contracts, the capitation payment to level four and five hospitals is Sh1,400, or around Sh350 per beneficiary every quarter.
However, NHIF branch managers are requesting that healthcare organizations share invoices at a rate of Sh250 for each beneficiary per quarter, which is equal to Sh1,000 for each beneficiary annually. Dr. Mwenda stated that the Sh1,400 would only be approved for people with chronic illnesses based on the informal information the facilities were receiving.
Capitation is based on the number of NHIF members assigned to a specific health facility and is paid in advance, just like it is for schools. RUPHA chairman Dr. Brian Lishenga said, “We are in the second month of the quarter and health facilities have not gotten their capitation, resulting in undue discomfort.” RUPHA is the representative of 367 healthcare facilities serving underserved communities in rural and urban areas, including Kangemi, Kayole in Nairobi, and Kisauni in Mombasa.