The National Hospital Insurance Fund has been relieved the mandate to accredit health facilities.
In the new reforms aimed at delivering Universal Health Coverage (UHC) by 2022, accreditation will be done by the Health ministry and the Medical Practitioners and Dentists Board.
“NHIF will move away from issues that are peripheral to it. The Ministry of Health and the board will carry out the work,” Health Cabinet Secretary Sicily Kariuki said.
She NHIF will come in after the hospitals have been accredited and gazetted.
Currently, NHIF is responsible for accrediting and reimbursing hospitals.
But there have been a lot of complaints that hospitals are colluding with the insurer to generate false medical bills for people who have not sought treatment. The Directorate of Criminal Investigations (DCI) is looking into how NHIF officials pocketed up to Sh12 billion from beneficiaries who had not sought medical treatment from any hospital.
The Health ministry and the medical board will monitor payments to hospitals, assess the quality of services Kenyans are getting and the competencies of the facilities.
Ms Kariuki said that with the reforms, every shilling spent by the insurer will cover two or three people.
“NHIF covers up to 20 per cent of the population today, yet the rates members are charged in any hospital is the same as in any private insurer covering one per cent of the population. The advantage gets lost because NHIF should play with its strength of economies of scale. This is what insurance funds in other countries where UHC is a determined journey are able to do,” Ms Kariuki said.
The new changes will make NHIF negotiate for quality service.