Author(s)

Nicholas Walter Otieno Ajwang

Department of Social Sciences, Pwani University, Kilifi, Kenya.

For many decades after independence, the Kenyan government ensured a vigorous pursuit of the National Hospital Insurance Fund (NHIF) coverage to those in formal employment and generally pursued a policy of laissez-faire as far as access to health insurance is concerned to those in the informal sector. At its inception, the NHIF, a social insurance scheme, was to assist government employees to gain access to higher quality private hospitals, thereby relieving congestion in the free public hospitals. Studies have shown that NHIF members contribute and hardly benefit from the fund. In fact, medical care use may not rise in response to an increase in the availability of medical insurance. There is evidence to suggest that even with insurance, access to healthcare may be difficult. For several decades, government health centers and dispensaries were not to be reimbursed by the fund, as it was restricted for use at hospitals. Today, the state has prioritized registration of the vulnerable (old, unemployed and those working in the informal sector) to the NHIF. However, the poor rarely use most of the registered health facilities with the fund for a number of reasons including distance. They use local clinics and dispensaries, which do not provide adequate health services. Therefore, they do not get reimbursed for the medical expenses they incur even when they are members of the fund. In addition, members of the scheme do not fully benefit from the fund because of cumbersome reimbursement procedures and limited coverage. NHIF mostly covers bed and food costs in private hospitals, and private wings in public facilities. Similarly, the increase in the number of people covered with private insurance is stunted by high risks resulting from administrative inefficiency and selective coverage of patients’ costs. During the Covid-19 pandemic, most private insurance companies pulled out of reimbursing Covid-19 treatment costs. Furthermore, private insurance firms mostly cover cooperates and individuals who can afford to pay private-insurance premiums. Kenya suffered from high Covid-19 infections over a period of one year from 2020 to 2021. The government did not have a clear-cut policy on payment of healthcare costs incurred as a result of Covid-19. Insurance companies walked away from covering pandemics. The result is the use of out-of-pocket payment for care. The main objective of the study is to rethink national health insurance coverage in Kenya in the wake of a global pandemic. Specifically, the study examined the role of health insurance in social protection during a pandemic, and gave recommendations for improving health insurance during a pandemic. The results of the study will improve our understanding of health insurance in Kenya. Data was collected in qualitative form. Data was collected through desktop research and in-depth interviews. Data was analyzed thematically. The result of the study indicates that health insurance can be a safe form of social protection and a means to improve access to healthcare during a pandemic. Finally, conclusions from the study are presented and recommendations for policy and further studies are made.

Healthcare, Health Insurance, Kenya, Covid-19 Pandemic, Social Protection

Ajwang, N.W.O. (2022) Rethinking Public Health Insurance Coverage in Kenya in the Wake of a Global Pandemic. Open Access Library Journal, 9, 1-8. doi: 10.4236/oalib.1109603.