Wellness & Fitness

Review NHIF contribution models for sustainability

nhif

The NHIF scheme as currently structured is not attractive to health service providers. FILE PHOTO | NMG

Health systems globally have individual weaknesses, each with its own inherent successes and flaws.

A few, however, stand out on the basis of generating less complaints than peers. This week I have been engaging with Canadian health practitioners on the positive and rave reviews their system enjoys.

Canada has a health insurance model consisting of multiple operators jointly providing coverage to all her citizens. Service provision is overseen through the central government, but each entity is separately administered by regional governments.

Every Canadian must have public health insurance — with the option of signing up for a private one for services not covered in the State system. A few pointers arising from the discussion suggest that there is need to tweak our National Hospital Insurance Fund (NHIF) to achieve this by interrogating our health strategy and long-term policies.

The first question is to ask ourselves whether we need to have parallel contributions running concurrently or consolidate the two into one. The private sector and the NHIF funds could be lumped together. Insurers would then be purely administrators, drawing funds from the same pot as claims come by.

Some countries have made it mandatory for all citizens to have health insurance but one has freedom to choose between the public and private service.

This, for instance, is the case in the German health system.

The second component is whether people should contribute a fixed amount of money or on a pro rata (in proportion to income) basis.

Critics of the pro rata model argue that it works best in countries with low unemployment rates. Kenya’s problem is that a majority of our citizens are informally employed.

In the same breath, should NHIF contributions be levied separately or should they be lumped together with other government taxes like VAT at the point of deduction? The government would then allocate a percentage of taxes raised to healthcare under NHIF’s administration. The blanket tax model is good as it captures those outside formal employment who escape the statutory NHIF deductions from salaries.

Household per capita expenditure outside healthcare among non NHIF members is high, with entertainment and lifestyle being competing priorities.

It is not uncommon to find households paying Sh800 monthly for cable television but not Sh400 as NHIF contribution.

Similarly, someone buys a Sh23,000 smartphone and is not covered by NHIF. Such scenarios show that even those with ability do not contribute for NHIF, lending credence to the need for alternative avenues to deduct contributions from them.

The NHIF scheme as currently structured is not attractive to health service providers. It must introduce exclusions as well as co-payments.