National Hospital Insurance Fund (NHIF) members can now access outpatient services from more than 2,000 hospitals and not a single facility in changes that will see visits to top facilities like Nairobi Hospital, Aga Khan and MP Shah limited.
The fund Wednesday said it will no longer be a requirement for members to receive outpatient services in a facility they had initially selected.
This means that members will be free to access more than 2,000 hospitals accredited to the NHIF including the high-end facilities like Aga Khan hospital, Nairobi Hospital and Karen Hospital.
Previously members were restricted to one hospital.
“I have come across several complains where a beneficiary travelled and became ill and he/she cannot be treated because they did not choose the nearby facilities,” NHIF chief executive Geoffrey Mwangi said yesterday.
“Capping has to be there to ensure sustainability as it helps in reducing wastage or unnecessary visits. Limits are pegged to the contributions made.”
Formal sectors workers contribute between Sh150 and Sh1,700 monthly depending on their income to the fund while the self-employed pay Sh500.
Private insurers put cash limit on outpatient services.
NHIF will provide the finer details of the outpatient service today.
“In line with these changes, members will no longer co-pay as was the case previously and will continue enjoying the same benefit package,” said Mr Mwangi.
This means the members will not be required to make cash payments on top of the NHIF share in the outpatient services.
NHIF last month added 204 public, private and faith-based hospitals and dispensaries to its list of accredited facilities, offering Kenyans more places for accessing healthcare.
The move comes amid a prolonged nationwide nurses’ strike that has seen more than 50 per cent of public health facilities remain closed since June, causing suffering and deaths, especially to hundreds of mothers during childbirth.
“We are geared towards providing more services and the more the hospitals the more the access to quality healthcare,” Mr Mwangi said.
Out of the new total, 18 facilities will cover eye, radiology, dental and laboratory services.
In August, NHIF begun a crackdown on hospitals making fake claims.