Petition NHIF to revise its rules on outpatient visits

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NHIF with effect from 1st November 2017 has changed the outpatient scheme from capitation fee to fee for service. The national scheme (where Kenyans pay Ksh 500 per month) and were accessing most of the outpatient services at designated facilities has now been capped at ONLY 4 visits per year PER CARD at a cost of Ksh 1,500 per visit! Drugs and laboratory tests have also been capped at Ksh 1500 each. Where a member/family has exhausted the maximum 4 visits offered, they will be expected to pay cash until the next financial year!

The purpose of a medical insurance is to take care of the uncertainties of health and protect the contributors against catastrophic events, and thus cushion against poverty. Limiting the number of visits especially for outpatient is wrong and discriminatory by all definitions. According NHIF....getting sick is by choice! And it has to be in turns in a Family. And you are only allowed a maximum of 4 visits. After that you are on your own!

This is the product of whimsical management. For all the years NHIF has been in existence, they have enough data to tailor benefits to every member profile down to a shilling; if they want to. Unfortunately, the philosophy at NHIF is not to invest the premiums back into a better health system for all.

No one is asking for an unlimited cover. Controls have to be put in place, but the same must be well thought of so as not to deny vulnerable persons the financial access to health services. There are better and more elaborate ways of curbing fraud, less of which occurs in the public hospitals as far as outpatient claims are concerned. Capping of the amount and visits to such a small scale in the context of the average Kenyan family size is not a creative way of containing costs.

By signing this petition, we recommend the immediate halt on such ridiculous caps and require NHIF to engage stakeholders to ensure equity of cover as we progress towards achieving Universal Health Coverage for Kenya!



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