Presented by: Sheila Gatu

August 14, 2019

Role of Private Insurance in a Reformed NHIF

AGENDA

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What is NHIF?Background

Membership Growth

NHIF Reforms Panelv Introductionv Thematic Areas

Role of Private Sector

What is NHIF?The National Health Insurance Fund

Established in 1966… Currently covers about 20% of Kenyan population

Expansion of Membership to informal sector

Enhanced benefit PackagesIntroduction of Out patient Cover

Emergency Road rescue and Evacuation Services

2006 2015 2017

Growth

2006

to

2017

NHIF REFORMS PANEL - 26 FEBRUARY 2018

Work Programme 1Legal, Regulatory and governance reforms

Work Programme 2Structural and business re-engineering reforms

Work Programme 3Strategic purchasing and financial sustainability

Scope of the Panel Work

Potential roles of Private Insurance

Complements coverage of publiclyinsured services or services withinprincipal/substitute health insurance, bycovering all or part of the residual costs(e.g. co-payments). System integrationwould be key

Covers health services already coveredunder public health insurance but withaccess to other additional providers orlevels of service, e.g. private healthfacilities, leads to competition

Duplicative Substitutive

Covers additional health services notcovered by the public schemedepending on the country, this mayinclude for example elective care,long-term care, dental care,pharmaceuticals.

Substitutes for cover which wouldotherwise be available from the publichealth insurance system, but theindividual has voluntarily opted out ofthis or is not entitled to it.

Complementary

Duplicative

Supplementary

Broader Possibilities….

Provide support in Health Technology Assessment.

Call center support services.

Partner with NHIF in creating awareness on the need for insurance.

Private insurance companies offering the UHC benefits package on behalf of NHIF e.g. in India.

Provide support to NHIF through Third Party Claims Administration of the UHC Scheme.

Partner with NHIF in the promotion of preventive healthcare via the use of technology such as wearable devices.

AnyQuestions

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