The gazettement of the Social Health Insurance Act regulations signalled that Kenya’s UHC train was on the move. There were some key issues raised during public participation that were incorporated and others were not.
Households with salaried income would contribute monthly contributions of 2.75 percent was not capped at the proposed Sh5,000 as initially expected. The contribution shall not be less than Sh300 with remittance being done by the ninth day of every month including public service and county employees.
Whereas a household whose income is not derived from salaried employment shall contribute to the Social Health Insurance Fund (Shif) annually at a rate of 2.75 percent of the household income as determined by the means testing instrument prescribed in the regulations.
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The means testing, put simply would be an exercise to determine household composition and socio-economic aspects. One epidemiologist referred to it as “similar to a census only shorter”, focused on the determination and estimation of the household income for the payment of the premiums set out in the regulations.
Some experts have queried funding mechanisms to conduct the means testing exercise and will they leverage existing databases, particularly at the county level?
Nevertheless, the National Assembly would be able to appropriate funds for indigents (those who can’t pay as can’t afford necessities), vulnerable persons and persons under lawful custody.
Biometrics capture
Kenyans would, however, have to register anew including biometrics capture for both contributors and beneficiaries above 7 years old. All those above 18 years old would be expected to register as contributors. Those under 21 years old with no income or under 25 years old but enrolled in an institute of learning could remain as beneficiaries.
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There were set guidelines involving the three funds that make up the Social Health Insurance Act, that is, the Primary Healthcare Fund, Shif and Emergency, Chronic and Critical Illness Fund.
The simplest is the government allocation or tax-funded Emergency, Chronic and Critical Illness Fund which would include contracted ambulance services. A shortlist of healthcare cases that would be considered emergencies from heart attacks to seizures was provided. Any accredited facility would be required to provide both resuscitation and stabilization services to any Shif member for a maximum of 24 hours. Members with chronic conditions would first utilize the benefits under Shif and once they exhaust their limits, could then access services under the Chronic fund.
The Primary Healthcare fund would cover care in healthcare facilities designated, levels 2 to 4. The essentials of Primary Healthcare Networks come into play as one starts with the lower-level facility and only presents to a higher-level facility upon receiving a referral note, apart from emergency services. How then would members know the facility levels? Previously, NHIF required members to select their nearest facility.
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SHIF, being the only contributory fund of the three would cater for services in levels 4 to 6 facilities which included specialized services. An excellent provision here is Mental Health and Palliative Services being covered.
Two crucial questions remain, ‘What would be the benefits?’ Following a member’s contribution what services would be covered and to what extent? The list of interventions to be included in the benefits package is still being discussed, by the Benefits Package and Tariffs Advisory Panel. On the other end of the spectrum, ‘What would healthcare facilities and providers be paid (Tariffs) for rendering these services?’.
The regulations clearly stated that the contributions made to the National Hospital Insurance Fund would be transferred to Shif and all data would be retained till all claims are settled to healthcare providers. In the next column, we discuss concerns facilities and providers have with regard to UHC.
Follow more UHC conversations weekly on one health lens podcast
Dr Wangari is a medical doctor.
Source link : https://nation.africa/kenya/blogs-opinion/blogs/road-to-uhc-the-elephant-in-the-room-when-it-comes-to-social-health-insurance-act-in-kenya-4647842
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Publish date : 2024-06-05 17:00:00
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