Govt Reveals How Hospitals Are Fleecing NHIF

  • The Ministry of Health has revealed how health service providers are fleecing the national medical insurance provider.

    Health Chief Administrative Secretary, Mercy Mwangangi, while appearing on Spice FM’s morning show The Situation Room, on October 6, 2021, stated that hospitals were fleecing the National Health Insurance Fund(NHIF) through dubious services. 

    The CAS further gave examples where NHIF had to pay more money for patients’ treatment.

    National Health and Insurance Fund (NHIF) Offices Building in Nairobi. Monday, November 18, 2019.
    National Health and Insurance Fund (NHIF) Building in Nairobi. Monday, November 18, 2019.
    Simon Kiragu

    “There was a woman who underwent hip surgery thrice. That shows that there was a failure on the doctor’s part. But guess what? We paid for each of the three procedures,” Mwangangi revealed.

    She also noted that hospitals were taking advantage of innocent Kenyans by carrying out many unnecessary tests.

    “We have seen complaints of patients who go to hospital and come out with a draft sheet of procedures to be done.”

    During the interview, the health official further revealed that the government was putting systems in place to tame the rising cases of such malpractice.

    “Now, what we will do is that we won’t pay. We will now pay pegged on the quality and outcome. These are big moves that will change the space in healthcare.”

    “We are moving towards a process where NHIF will pay not just because you did a cesarean section, but you did a service that led to a good outcome,” she stated.

    Mwangangi also added that the government would ensure that unnecessary tests become a thing of the past. 

    “What we are actually doing is coming up with a system of pay that actually bundles the tests. For example, if a patient is being treated with diabetes, NHIF will know the tests that will be required for that,” Mwangangi revealed.

    The CAS noted that their new directive will create change within the healthcare system.

    “What will happen is that there will be a change of behavior of the providers.”

    A doctor carrying out tests at the Kenyatta National Hospital.
    A doctor carrying out tests at the Kenyatta National Hospital.