Early last month, one of my cousins, who is suffering from a recurring cancer condition, detected a fresh lump. After assessment by the local physicians, it was agreed that he needed to be taken to India where the initial operation was undertaken.
At first while he was admitted to one of the local hospitals he knew the bills would be taken care of while in India, after all, although he is not formally employed, he is a regular contributor to the National Hospital Insurance Fund (NHIF) individual scheme and in addition had taken an executive private health comprehensive cover with a limit of Sh3 million from a leading private insurer.
It is while he was at the hospital with the guardian that he realised that although the health insurance has a Sh3 million limit, it only covers a maximum of Sh500,000 for cancer ailments. The only option was to fundraise.
The mitigation he thought he had put in place was actually a transparent wall. It did not help. The main question hence is what works fully for an average Kenyan who is not formally employed in private and public sector and doesn’t have a Sh 1 million as disposable income and security for healthcare in case of an eventuality?
This got me thinking. A desktop research of the three leading private insurers who also offer health cover reveals something not always given a thought but serious.
For the individual health insurance packages offered by all three, and in selecting the most executive, they range from Sh3 million to Sh4 million limit, in all, cancer is allocated a maximum of Sh500,000 only, and it should be after a year for one to benefit. The same applies for kidney ailments.
This information on specifics is never revealed at the point of sales, only the general upper limit is always talked about. Does this have to do with why health insurance uptake is very low ?
Definitely, after such an incident will you go back to paying or will your friends or family members subscribe to the scheme? It had failed at the hour of need.
A normal and average surgical cancer or renal operation costs an upwards of Sh1 million. Surely, the best health individual cover should at least be able to cover a single operation, but no, it is enough to offset only part of the budget, Sh500,000 to Sh700,000.
It is time private insurers be realistic in their packaging and pricing on their schemes. In benefiting, you enroll a lifetime member and others who have testimonials from a single life opening coverage. End result is more people joining, because it will work for you.
It is factual to say the National Hospital Insurance Fund (NHIF) has been a life saver, especially for the many who are not employed and are subscribed to the monthly pay up system. But there is room for improvement. As a public health insurer, the NHIF should not be too minded on making too much profit but breaking even after the customers have been compensated.
Case in point, it does not make sense for the NHIF to cap their surgical cancer operations and renal ailments at Sh500,000 when clearly treatment of such diseases average Sh1 million. This is denying someone an opportunity to get treatment while the organisation declares huge profits.
Solution is therefore for this public insurer to expand their benefit bands and help more of those suffering from cancer and renal diseases. The second option would be to have a dedicated separate fund to take care of the members by catering for treatment until one gets well irrespective of the bill.
The NHIF should also invest the billions of profits in long lasting scheme.
As radical as it may be, but the insurer should run referral hospitals, resulting in better services, modern infrastructure and equipment as well as well paid and skilled doctors. This would cut costs, especially the bills it settles for members seeking treatment abroad.
More than 10,000 Kenyans spend over Sh10 billion annually in treatment to India. This can be mitigated if the level of service delivery at referral hospitals is at par with India.
Private investments in health is a good thing but it should not at the expense of provision of affordable and universal health care to all.