KENYA – The Government of Kenya, through the National Health Insurance Fund (NHIF), has unveiled a Benefit Package for the contracting period 2022-2024 contracting cycle, in a move to build NHIF’s capacity as the most sustainable mechanism of effecting Universal Health Coverage in the country.

National Health Insurance Fund has launched new contracts accommodating the concerns of Kenyans and accredited hospitals for standardization of reimbursement rates across all Healthcare Proxies (HCPs), as per the Kenya Essential Package for Health (KEPH) Levels of care.

For instance, Dialysis is covered comprehensively in over 50 healthcare providers countrywide while radiology/medical imaging benefit has been enhanced to include access to mammography, fluoroscopy, ECHOs, EEGs and specialized ultrasound imaging for all beneficiaries.

The Health Benefits Package also includes the Medical Outpatient cover, Oncology Benefit which has been expanded to cover bone scans and radionuclide therapy, Surgical Benefit package that has been doubled along with the enhancement of Mental and Behavioral Health benefits package.

National Hospital Insurance Fund is a State Parastatal that was established in 1966 as a department under the Ministry of Health. The Fund’s core mandate is to provide medical insurance cover to all its members and their declared dependents (spouse and children).

Earlier, Kenya’s Ministry of Health commissioned the Health Financing Reforms Expert Panel (HEFREP) to design an affordable, responsive health benefits package for the delivery of Universal Health Coverage as well as position NHIF as a strategic purchaser of health services to attain UHC.

Health Cabinet Secretary Mutahi Kagwe explained that to improve strategic purchasing, NHIF is required to identify the interventions or services to be purchased based on the needs of Kenyans, national health priorities and cost-effectiveness.

The Health Benefits Package Advisory Panel (HBAP) worked closely with the Ministry of Health, the County Governments, stakeholders and the public to define the Health Benefits package which will form the starting point of the UHC journey.

Subsequently, the National Health Insurance Fund has enforced various reforms to improve operational efficiencies to effectively deliver on its mandate on the national rollout of the Universal Health Coverage such as the element of access of services.

NHIF has imposed radical changes such as the amendment of the NHIF Act to accommodate the changing healthcare ecosystems dynamics, lobby for the push of the contracting cycle to 1st July 2022 as well as the name change from National Hospital Insurance Fund to National Health Insurance Fund.

During the NHIF’s Health Benefits Package launch, Cabinet Secretary Mutahi Kagwe explained that the strategic standardization of hospital contracts is critical to increase quality of care, efficiency and productivity which is greatly significant to the implementation of UHC in Kenya.

Mutahi Kagwe pointed out that that comprehensive contacts involves NHIF members will walk in and walk out without paying while in non-comprehensive contracts, if a NHIF member chooses to go to a particular health facility then they would top up.

Initial government and faith-based hospitals have comprehensive contracts while the private hospitals have a non-comprehensive contract. NHIF members will access services in more than 7,600 healthcare facilities spread across Kenya out of which 80 per cent are comprehensively contracted,” he added.

Kagwe acknowledged that the Ministry of Health, NHIF and hospitals have held extensive stakeholder engagements on strategic purchasing to ensure Kenyans access healthcare without suffering financial hardships as well as lauded health industry stakeholders for promoting sustainable healthcare.

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