One of the key principles of social health insurance is solidarity. Ideally, a well-designed social health insurance system should ensure that contributions are according to means, and benefits according to needs. As such, the rich contribute more than the poor, but all access benefits based on need. The inherent value of such a system is that the strong in society support the weak i.e. the rich pay for the poor; the young pay for the elderly; and the healthy pay for those in poor health.
The National Hospital Insurance Fund (NHIF) has been going through numerous changes all aimed at increasing membership coverage and providing a better benefit package for its members. It has for instance adjusted monthly contributions upwards. For the self-employed, monthly contributions have risen from KShs. 160/- to KShs. 500/- (an increase of about 200%). For the formally employed, the contributions have risen in a graduated structure, based on income brackets, with the highest earners’ contributions rising by about 400%. Further, NHIF is also in the process of moving from an in-patient only cover, to a more comprehensive package covering both in- and out-patient services.
All these changes are generally in the right direction, and NHIF now has the task of putting the right systems in place to ‘deliver the promise’. Unfortunately, one of the downsides of the changes has been protests from target groups. Some persons in the informal sector have complained about the sharp rise in contributions, and argue that they will not be able to afford the new premiums. Some formal groups eg. Teachers under their umbrella body (KNUT) have strongly opposed the introduction of the new rates. NHIF now has the task of finding a formula to attract and retain all would be members into the scheme and form a strong pool, so as not to miss out on the benefits of the solidarity principle. This is the only solution to dealing with challenges such as adverse selection where it attracts only those in need of services (at least from voluntary members); and reduction of pool size if some potentially strong groups opt out, or are considered under separate pools eg. as is currently happening with the Civil Servants scheme.
To ‘deliver the promise’ NHIF will need a strong and consolidated fund pool. This will be achieved through attracting and retaining the rich and the poor, the young and the elderly, the healthy and those in poor health. A prerequisite to this is to offer a benefit package that is viewed by members to be worth their contributions, both in terms of range and quality of services available.
The GIZ Health Sector Programme is providing technical support to NHIF to enable it come up with good strategy to achieve this. One of the areas that the programme is supporting is the development of an informal sector strategy that will enable NHIF understand and address the needs of persons in the informal sector. This then allows NHIF come up with products that can attract and retain persons in the informal sector.2015-05-20