Like any developing country,
Kenya faces challenges in ensuring the national and county budgets balance and
that there is good distribution of resources .It is for this reason that the
Ministry of Health including the devolved functions of service delivery in
public health facilities would get only 3.7% of the government budget. Health
is a driver of GDP growth of a nation and the greater your investment in it the
better the returns on GDP. So I just call on the county and national governments
and related bodies to evaluate how to implement and continue improving the
following to enhance healthcare service delivery and health in Kenya.
Review NHIF and other insurers’ payment methods and reimbursement rates
Recently NHIF introduced greater
coverage for contributors both in private facilities seeking surgical
interventions. These Increased payouts from NHIF towards surgical cases may
seem like a great idea, in fact there have been human interest stories in local
press touting how much of a relief it is for the common man.
However, let’s remember that there is wide variation in the cost of care in different facilities even though the surgical procedure may be the same and the surgeon probably the same.For as long as there is no benchmark rate applicable in all facilities then the cost of care will continue to rise.The
government hospitals could do the same surgeries at a fraction of the cost. NHIF
does not reimburse at the same rate for the two facilities. For example, a
surgery for appendectomy at a government facility is not reimbursed the same
rate as private facilities. Am sure if the government facilities were
reimbursed the same, the burden on the tax payer for recurrent expenditure in
terms of emoluments for doctors would be a thing of the past. The county
hospitals would be able to sustain the operations and even subsidize the county
governments’ other functions through returns from NHIF. What county governments
should fight more should be greater coverage of NHIF in public facilities and
improvement of the facilities and terms of service of all health workers in
order to even attract private insurance providers to utilize their facilities. Better
equipping county hospitals would in the end have greater benefits in terms of
increased payouts from NHIF and other insurances.
There is also a need to re-look at
our overall provider payment methods.Hospitals would prefer to continue with the status quo of fee for service because they are cushioned against any losses. while insurances might prefer to try a different model.You can read more about this: Read:Taming Runaway Healthcare Costs
Invest in preventive healthcare and population health management
programs
In as much as treatment of
diseases is important, the greatest impact of interventions can be realized
through public health programs of better access to water, sanitation and other
environmental health determinants. Counties need to invest more in proper
utilization of the health data in their areas to improve the environment and
healthcare outcomes for the citizens’ .They also need to ensure better water
supply, treatment and proper sewage treatment and drainage systems.
Increase tax-funded health coverage in public hospital
If the above and other
interventions involving no increase in health budget fail we would have to
increase the tax-funding for health. On many occasions I have elaborated that
in a society like ours, health-insurance schemes would have challenge of
sustainability because of our not so “peculiar” habits. Currently the formal
insurance penetration rate in Kenya is still very low despite the availability
of the NHIF which has a big potential population. In the recent past there have
been attempt to encourage more people to join the NHIF through voluntary contributions.
This attempt has increased the risk in NHIF, one called adverse selection. Adverse
selection arises when the population covered by an insurance starts to comprise
more of the sicker members of the society rather than a blend of young, healthy
population and older, sicker patients. The level of adverse selection that the
system can take depends on many factors and only hope can save NHIF if it continues to embrace this system. Furthermore,
we traditionally have an informal social health insurance in the form of Harambees
which have made it difficult for us to adopt the western concept of insurance. This
calls for a rethink of the insurance programs to adhere to the needs of the
population and develop products that meet these needs rather than chock the populace
with a one size fits all system. Alternatively the government just needs to improve
the service delivery in public facilities and with a minimal co-pay method to
sustain the operations of the hospitals together with the tax-funding.
These are not the only viable options for improving healthcare in Kenya,but just my thoughts and how I think we could proceed,Other alternative ways can be sought also.In the meantime I just sit here hoping against all hope that sanity in healthcare leadership prevails and that the poor of this nation benefit from affordable,quality care.
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