The National Hospital Insurance Fund beneficiaries in rural areas will now be required to pay cash when they visit their member hospitals, according to Brian Lishenga, executive committee chairman of the Rural Private Hospitals Association of Kenya.
Lishenga stated that this occurred as a result of NHIF’s failure to meet the financial commitments set forth in the contract with healthcare providers.
“Health facilities under RUPHA will now require patients who are beneficiaries of the NHIF Capitated Schemes to pay in cash to access services. This is because the board has failed to honour its financial commitments.” He said.
According to Lishenga, the new directive will take effect on May 31. He added that NHIF violated Schedule 1’s Articles 1.3.1 and 1.3.2, which deal with capitation payments.
Clause 1.3.1 states that “The Board undertakes to pay to the health facility for a Beneficiary of the National Scheme, a capitation amount of Sh1,000 per beneficiary per annum within the first 30 days of the capitated period.”
Clause 1.3.2 specifies that “The Board undertakes to pay to the health facility, for a beneficiary of the Managed Schemes without limits, a Capitation amount of Sh2,850 per beneficiary per annum within the first 30 days of the capitated period.”
Lishenga stated that RUPHA has repo that as of May 29, NHIF has not made the requisite payments to health facilities for the April-June 2023 quarter; these payments are due within the following seven working days.