The National Hospital Insurance Fund (NHIF) is set to lose its power to choose hospitals for card holders in a raft of measures being put in place ahead of the universal health coverage rollout.
The accreditation of health facilities will henceforth be undertaken by the Health ministry working in partnership with the Kenya Medical Practitioners and Dentist Board (KMPDB), Cabinet Secretary Sicily Kariuki said.
“We are cleaning up the process of accrediting facilities because for us it is helpful in achieving functioning referral mechanisms,” she said.
Ms Kariuki said health facilities will be reviewed in terms of qualifications of the staff, physical location, size, number of patients, specialists and other services on offer.
To access comprehensive outpatient medical cover at the moment, card holders and their dependents are required to select a health facility from the NHIF list of contracted outpatient service providers.
The facilities are categorised from the lowest, Level One, to the highest, Level Six, with the five categories being under management of counties.
Level One has community health facilities while Level Two has medical clinics.
In Level Three are health centres while Level Four has full hospitals.
In Level Five are county referral hospitals while national referral facilities fall under Level Six.
Ms Kariuki said that ceding the accreditation role to the government would ensure that patients do not rush to national referral hospitals before going through primary service facilities.
The move is part of the process of transforming and repositioning NHIF as a key player in Kenya’s journey towards universal health coverage.
“NHIF will move from issues that are peripheral to it including accreditation of providers and facilities because that work belongs elsewhere,” she said.
The insurer pays health facilities according to the number of its members who have chosen them as their preferred facilities.
The CS was speaking during the launch of a health financing reforms experts’ panel