- The NHIF Exit Report 2024 noted that only 7.1 million of the 16.2 million registered members were actively contributing
- There was a disparity of over 9.1 million members, with over 56% of enrolled individuals being inactive compared to the 8.8 million dormant members in the previous year
- President William Ruto said all medical institutions having claims of KSh 10 million or less that were contracted by the now-defunct NHIF will get full reimbursement
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Japhet Ruto, a journalist with TUKO.co.ke, brings more than eight years of expertise in reporting on finance, business, and technology, delivering in-depth analysis of economic trends in Kenya and worldwide.
New disclosures reveal that more than half of the members of the now-defunct National Health Insurance Fund (NHIF) defaulted on their monthly contributions to the new scheme, the Social Health Insurance Fund (SHIF).
SHIF came into effect in October 2024, replacing the now defunct NHIF, which President William Ruto has accused of massive corruption including inflated medical bills and payment of non-existent claims.
The failure by millions to transition and make timely payments to the the new scheme adds to the financial strain on the new public health insurance and casts doubt on its long-term viability.
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How many ex-NHIF members defaulted on SHIF?
The NHIF Exit Report 2024 noted that only 7.1 million of the 16.2 million registered members were actively contributing.
There was a disparity of over 9.1 million members, with over 56% of enrolled individuals being inactive.
This was compared to the 8.8 million dormant members from the previous year, reflecting a 300,000 rise.
“In the reporting period, 8,464,880 claims were processed with a total of KSh 57,776,829,383 paid, while capitation monies paid out totaled KSh 7,287,347,302,” the report stated.
During the period under review, there were 7,106,911 active members in all, representing formal, informal, and sponsored programme categories. This represented 44% of the 16,210,351 total enrolled members.
What NHIF paid
The defunct NHIF paid out a total of KSh 70.9 billion in benefits during that time, compared to KSh 81.6 billion in premiums and contributions.
For every KSh100 in premiums collected, KSh 87 was spent on claims and expenditures, resulting in an 87% loss ratio.
The claims ratio rose from 83% the year before, suggesting that beneficiaries were using healthcare services more frequently.
The expansion of healthcare benefits, increased frequency of hospital stays, and the growing expense of medical services were some of the factors that led to the growing claims load.
Healthcare providers were waiting for KSh 25.4 billion in reimbursements, and the government owed NHIF KSh 30 billion in unpaid premiums.
When will NHIF debt be settled?
On Wednesday, March 5, President William Ruto said all medical institutions having claims of KSh 10 million or less that were contracted by the now-defunct NHIF will get full reimbursement from the government.
According to Ruto, 91% of all hospitals covered by NHIF were public, private, and faith-based hospitals.
However, he pointed out that hospitals with claims above KSh 10 million will have to go through a verification process, which must be finished in 90 days, before a payment schedule is decided.
Why hospitals suspended SHA services
Ruto made the pledge after more than 600 Kenyan hospitals affiliated with the Rural-Urban and Private Hospitals Association of Kenya (RUPHA) suspended SHA services.
Brian Lishenga, the chairman of RUPHA, cited the government’s unmet commitments.
He accused SHA’s management of being incompetent and uninterested in addressing the current issues.
SHIF debate rages on in the country
SHIF has continued to dominate debate in the country since coming into force with President Ruto and his allies defending it as the ultimate plan to provide Universal Health Care in Kenya. But there have been numerous reports of the system not working properly in health facilities. Others have claimed the amounts settled are too low.
The health ministry has admitted that there are challenges in fully implementing the system and has made several changes including the setting up of a 24hr hotline to help deal with the numerous complaints from Kenyans.
Proofreading by Jackson Otukho, copy editor at TUKO.co.ke.
Source: TUKO.co.ke
