Earlier this month, we published an article that discussed the various issues facing health insurance programs in the United States. Today, we turn our attention to Kenya and explore the challenges facing health insurance programs in this African country.
Despite the Kenyan government’s efforts to expand access to healthcare through various insurance programs, many citizens still lack access to quality healthcare services. This article will delve into the specific challenges facing health insurance programs in Kenya and suggest possible solutions to address them.
Kenya has a mix of public and private health insurance programs, which aim to provide access to affordable and quality medical care. The National Hospital Insurance Fund (NHIF) is the largest public health insurance program in Kenya, covering over 7 million Kenyans. The NHIF covers both inpatient and outpatient services, including surgery, maternity, and specialized treatment.
In addition to the NHIF, there are several private health insurance companies in Kenya that provide health insurance coverage to individuals, families, and corporate clients. These private health insurance companies offer a range of medical services, including consultations, laboratory tests, surgeries, and maternity care.
Some of the private health insurance companies in Kenya include AAR Health Services, Britam Health Insurance, Jubilee Insurance, UAP Old Mutual Health Insurance, CIC Health Insurance, APA Health Insurance, among others. These private health insurance companies offer comprehensive medical coverage, including inpatient and outpatient services, maternity, and dental care.
The Kenyan government has also established the National Hospital Insurance Fund (NHIF), which aims to provide access to affordable healthcare to all Kenyans, regardless of their income. The NHIF covers all formal and informal sector workers.
Health insurance programs play a critical role in providing access to medical care to millions of people in Kenya. However, there are several issues facing these programs, including inadequate funding, limited access to healthcare, low insurance penetration, and fraud and abuse. In this article, we will explore some of the issues facing health insurance programs in Kenya, with real-life examples.
Issue 1: Inadequate Funding
One of the most significant issues facing health insurance programs in Kenya is inadequate funding. Healthcare funding in Kenya is mainly dependent on government funding and donor support. However, the government funding for health is often inadequate, leading to a lack of essential medical equipment and drugs.
For example, in 2019, the Kenyan government cut funding for the National Hospital Insurance Fund (NHIF) by Ksh 6.6 billion, affecting the delivery of healthcare services to Kenyans. This lack of funding has resulted in long wait times for medical procedures and a shortage of medical personnel in many public hospitals.
Issue 2: Limited Access to Healthcare
Another critical issue facing health insurance programs in Kenya is limited access to healthcare. Despite the existence of health insurance programs such as NHIF, many Kenyans still lack access to essential medical care. This is especially true for those living in rural areas, where healthcare facilities are often inadequate or non-existent.
For example, a study conducted in 2017 found that only 4% of Kenyans living in rural areas have access to health insurance, compared to 18% of those living in urban areas. This limited access to healthcare has resulted in a high burden of preventable diseases such as malaria, HIV/AIDS, and tuberculosis.
Issue 3: Low Insurance Penetration
Another significant issue facing health insurance programs in Kenya is low insurance penetration. Despite efforts to increase insurance penetration, the majority of Kenyans do not have health insurance coverage. This low insurance penetration has resulted in a significant number of Kenyans paying for medical care out of pocket, leading to financial strain for many households.
For example, a study conducted in 2019 found that 80% of Kenyans pay for medical care out of pocket, with only 20% having health insurance coverage. This low insurance penetration has also resulted in a lack of competition among insurance providers, leading to high insurance premiums.
Issue 4: Fraud and Abuse
Another issue facing health insurance programs in Kenya is fraud and abuse. Fraudulent activities such as billing for services not provided or charging for unnecessary medical procedures can drive up healthcare costs and reduce the quality of care.
For example, in 2018, the NHIF announced that it had lost Ksh 1.5 billion to fraud and abuse. This loss of funds has resulted in a lack of funding for essential medical equipment and drugs, leading to a decline in the quality of healthcare services provided by the NHIF.
Health insurance programs in Kenya face several issues, including inadequate funding, limited access to healthcare, low insurance penetration, and fraud and abuse. Addressing these issues will require a collaborative effort between healthcare providers, insurance companies, policymakers, and individuals to ensure that everyone has access to affordable and quality medical care. This can be achieved through increased government funding, improving healthcare infrastructure, increasing insurance penetration, and implementing measures to prevent fraud and abuse.
References:
- Kenya Health Financing Strategy 2018-2022. (n.d.). Retrieved April 26, 2023, from https://www.health.go.ke/wp-content/uploads/2020/11/Kenya-Health-Financing-Strategy-2018-2022.pdf
- Kenya Demographic and Health Survey 2014. (n.d.). Retrieved April 26, 2023, from https://dhsprogram.com/pubs
