PHA-Exchange> Transforming health care financing system

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From: "Richard G. Wamai" <rgwamai at yahoo.com>

> In an earlier contribution.....  I gave a
> brief of Kenya's statutory health care financing
> scheme - the national Hospital Insurance Fund (NHIF).
> I feel it necessary to make another contribution in
> light of a recently launched bill that proposes the
> transformation of the NHIF into a national social
> health insurance scheme. This information is fresh and
> has been documented today.The following is a brief:
> 
> Called the National Social Health Insurance Strategy
> (NSHSI), the bill proposes that all fees for basic
> hospital care regardless of the disease of
> socio-economic status be fully covered by the
> government. These include doctor's fees, bed and
> drugs. In order to finance the scheme to cost Ksh40
> billion annually, the Strategy requires that all
> Kenyans and permanent residents contribute between
> Ksh400 and Ksh600 per year. Those in formal employment
> will contribute through their work place while those
> in the informal sector will put in Ksh400 through
> their trade associations and women groups. This will
> bring in Ksh12 billion and Ksh10 billion annually
> while taxation on tobacco and alcohol will add Ksh11
> billion. The taxation and other revenue will help the
> government cover those unable to pay the premiums.
> Because of its universal and comprehensive coverage
> and that every person rather than household
> contributes, the compulsory scheme will differ sharply
> from the NHIF. Announcing the social health insurance
> scheme, the Minister of Health said it would be
> operational by July 2004 with the Ksh6 billion NHIF
> assets forming the initial capitalization. There is
> every reason to expect that the system will be
> implemented as the new Narc government has pledged its
> commitment to the reforms and health system renewal.
> The key challenge to its successful and effective
> implementation will be management in particular regard
> to the installation of a system of registering all
> salaried persons and deducting their premiums, and the
> identification of poor persons who are unable to pay
> for whom the government must then cover.
> 
> Postcript: 
> 
> This system will effectively place the government as
> the (sole) buyer of health insurance. How the Health
> Maintenance Organizations (HMOs) that currently offer
> medical insurance cover, e.g., British-American and
> many others, will transform will be an interesting
> scenario to watch. The new system has been likened to
> the one in place in South Korea and Colombia.    
> 
> Richard Wamai
> University of Helsinki,
> (Currently at the Nordic-Africa Institute, Uppsala, Sweden)