Sunday, April 22, 2012

Universal healthcare? Not with NHIF

Sunday Nation 22 April 2012

The National Hospital Insurance Fund (NHIF) is in the process of implementing what they are calling comprehensive cover for all their contributors. The plan is supposed to be in operation for teachers and other civil servants who should, by now, be covered for both outpatient and inpatient services at hospitals all over the republic.

As predicted, the plan is already facing problems, with accusations being made that NHIF has already disbursed funds to non-existent or ill-equipped facilities to render services to its members.

This concern was first publicly raised in this column on January 15 this year, where it was noted that:
“Two of the contracted private providers do not have sufficient facilities of their own, and it is clear that they will only serve as middlemen in the process. Some of the ‘clinics’ identified on their websites are actually non-existent, and it is even doubtful if they have enough workers to offer quality health care to members of Kenya’s civil service”.

These are the same issues now being investigated by various arms of government, and it appears possible that some fraudulent activities may have occurred.

The justification the government has given for rolling out this scheme is that it is part of endeavours to provide universal healthcare to the Kenyan populace. Indeed, this is the thinking behind the plan by NHIF to increase members’ contributions in order to cushion the less fortunate members of our society and improve health care delivery.

The NHIF contribution, being compulsory, constitutes a tax on the employed workforce’s income. Initially, it was meant to assist the contributor to offset hospital costs for themselves and their families.
The intention of raising the contribution, however, is to ensure that all Kenyans gain access to essential healthcare as part of the government’s obligation under the Constitution.

We have argued before that whenever government intends to raise taxes it goes through Parliament, which has the constitutional mandate to oversee the collection and utilisation of taxes on our behalf. NHIF is not following this procedure, citing the Act of Parliament that set up the Fund.

Instead of ramming this increment down Kenyans’ throats, this obvious oversight suggests that perhaps this Act needs to be repealed, and replaced with provisions for a health tax that will guarantee essential healthcare for all Kenyans.

Since NHIF’s expenditures are not directly supervised by Parliament, raising the contribution without consulting the contributors, and intending to use the money for purposes other than providing for the care of the contributors themselves, contravenes the principle of representative government. It is taxation without representation.

As we noted in another article in August 2010, the law allowing NHIF to make such unilateral decisions “is bad law inasmuch as it lets a government institution impose extra taxation on Kenyans without parliamentary approval.”

If NHIF persists in this folly, it is a sure bet that those of us who really desire improvement in the health care delivery system in Kenya will fight for the dissolution of this ill-conceived entity, and raise in its place a National Health Fund to collect and distribute funds for the purpose of providing health services.

The only difference will be that this Fund will raise money through taxation and operate under parliamentary oversight, hopefully preventing pilferage and waste as is now the case.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University School of Medicine

1 comment:

  1. I agree with you. I see too many people unable to get health care. Too many needing to decide between prescription drugs and food. The current system, based in capitalism, has failed. The universal health care system may not be perfect, but the status is must change.

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