Health insurance uptake has over the years been very minimal especially amongst individuals and families. Most of the privately insured are those who get covers through their employers or their SACCOS or social groups. For the rest of privately insured, the greatest challenge has been the premiums which according to most, are very high. The others have joined the NHIF schemes. Majority of Kenyans access healthcare services using out of pocket payments.
Introduction of more services and benefits by NHIF have greatly changed the health insurance industry. This is because, there now are packages that with minimal contributions one can access medical attention for both in and outpatient services beyond the daily rebate for inpatient. This means that one can be admitted in a government facility and some faith-based facilities and the bill is fully paid for.
In light of this development, Jayesh Saini opines that it would be prudent for the private insurance sector to provide packages that are competitively priced so as to be accessed by more people while at the same time remaining in business. One way that this can happen is a collaboration between them and the NHIF to introduce “top-up” packages for individuals who would prefer specific health facilities or extra services not covered under the NHIF packages, whether it be in or outpatient services. This will especially be beneficial when considering the rollout of UHC and the registration for the NHIF cover. Especially so critical will this be if the government’s intention of having every person enrolled in an insurance cover is enforced. More financial resources will be accrued so that even the indigents have a coverage without too much from the pockets of individuals or the government coffers.
As observed by Jayesh Saini, private insurance plays a critical role of ensuring there is equity and now is a great moment for them to proof that they are concerned about the wellbeing of their clients and not just the bottom-line. They must arise and play a more proactive and bigger role to ensure that UHC does not stall or fail. Having been exposed more on premium calculations and setting, fraud detections, claims management and other insurance related activities, they should be able to have round tables with NHIF to assist develop packages that are not only affordable but also those that actually provide sufficient healthcare coverage to the people so they are not left exposed to financial hazard due to half done service delivery.