NHIF calls meeting after uproar over dialysis cover

Sunday, October 31st, 2021 00:00 |
A kidney patient undergoes dialysis. Photo/PD/File

National Hospital Insurance Fund (NHIF) convened a make-or-break meeting this morning with kidney specialists and patients over the proposal to cut dialysis reimbursements by Sh3,000.

Though the NHIF has suspended the decision to reduce the reimbursement from Sh9,500 to Sh6,500, until the end of the year after consultations with stakeholders, patients and nephrologists are crying foul over the move that could see the former being forced to cater for the Sh3,000 difference.

In the new scheme, NHIF will categorise units into comprehensive and non-comprehensive.

In the comprehensive category, patients will not be expected to pay additional fees to top up for their haemodialysis sessions.

In the non-comprehensive category, patients will top up for their sessions.

A document circulated by NHIF to facilities offering dialysis indicates that the proposed rates have been arrived at based on the analysis that showed that on average, government facilities charge Sh5,000 and private dialysis centres charge Sh6,500.

NHIF also proposes that the number of dialysis centres be increased from two to three in a week based on the global best practices. This means that dialysis patients will require an extra Sh9,000 every week to top up the NHIF paid fee.

“It is also proposed that stand-alone dialysis centres shall be contracted on a comprehensive basis, and must have an ICU or a service level agreement with a Level 5 hospital,” NHIF states in its proposals.

Own pockets

Already, the Kenya Association of Private Hospitals has threatened to stop rendering dialysis services to patients under NHIF cover due to the cost implications should the proposal be effected.

“Following the recent development on the benefits packages review, NHIF plans to engage stakeholders to chart a way forward. The engagement will evaluate the cost and financing of renal dialysis, among other issues,” part of the invite letter sent to stakeholders last Friday stated.

Yesterday, Dr Jonathan Wala of the Kenya Renal Association said the NHIF move is meant to reverse the gains made in the treatment of kidney problems.

“We who are a bit older remember the days when patients paid for dialysis out of their own pockets. How they sold family assets to pay for a few more sessions of dialysis.

How they borrowed from friends, then from banks and then from Shylocks,” Dr Wala, a consultant at Aga Khan and Ladnan hospitals in Nairobi said.

He added: “How they woke up at 2am to be in the queue at KNH because that was the only available and affordable place.

How they dialysed once every 2 weeks and had Hb’s of 6 or 7. How they eventually died horrible deaths, often drowning in pulmonary oedema.”

Dr Wala claimed that some forces within NHIF and the Ministry of Health are out to sacrifice patients’ lives at the altar of a single player in the “market” of dialysis.

“Isn’t it time to rise up and use whatever means we can to fight for the health and lives of these dear ones against those who want them to go back to those dark miserable days,?” he posed.

Wala said some forces were pushing NHIF to commission private individuals from India to set up dialysis units that will accept lower fees.

To achieve this, the Kenya Renal Association says, will entail the individuals taking shortcuts, such as reusing dialysis membranes, which are detrimental to the patients lives.

“In India where the reuse of membranes is done, it is associated with a lot of complications such as increased bacterial infection rates and hepatitis infections,” he says.

Dr Abdi Mohamed of the Kenya Association of Private Hospitals said they were contemplating stopping offering dialysis services should NHIF implement the proposed fees.

He said that except for the machines, every item used in the dialysis procedure is for one-time use, and some products, such as filters, are subjected to VAT, which makes the procedure expensive.

Kidney transplant

Total costs including medication and food for the patients as well as immunity boosters come to no less than Sh8,000.

The country has only 54 public dialysis centres, serving 25 per cent of the patients against 142 private ones that cater for more than 66 per cent of the patients.

There are also 17 faith-based medical centres that cater for the remaining 7.9 per cent to bring the total number of the centres to 213.

Kenya has 44 nephrologists and 600 renal nurses serving a total of 5,670 kidney patients.

Some 661 Kenyans have undergone kidney transplant, with 41 having undergone the operation this year alone.

Most nephrologists are based in private facilities while government hospitals are forced to deal with general physicians.

John Ngigi, the head of Renal unit at KNH, says reducing the reimbursement would force many patients to drop out of treatment.

“NHIF is leading the nation into a major catastrophe where thousands of haemodialysis patients will die if they insist on reducing the reimbursement for patients undergoing haemodialysis,” Dr Ngigi warned.

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