Only 20 per cent of Kenyans ( 11 million out of about 55 million Kenyan population) have any form of Health Insurance even as the country is geared towards Universal Health Coverage (UHC).
This is according to the Draft Kenya Comprehensive Medical Report that showcases that the health sector is facing increasing low levels of public health insurers penetration, and low levels of overall UHC.
The report proposes changes to the current health insurance regulatory framework in a bid to increase penetration as well as enable the private sector to contribute to achieving the government’s goal of UHC.
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The draft report that has been developed by i3 Actuaries and Consulting team who were contracted by National Treasury proposes to bring community-based health within the regulatory of the Insurance Regulatory Authority (IRA) as well as licensing and regulating Health Maintenance Organisations as a new license category at the IRA.
In addition, the report proposes that all policyholders should have access to the same policy options and be included in the same risk pool while a prescribed minimum benefits (PMB) package for all health insurers should be implemented.
“There should be provision for regular review and amendment to the PMB package to adjust for changes in affordability and the overall disease burden,” the proposal document states. In addition, the document proposes that IRA should have the power to enforce corrective measures on market players who are setting unreasonably low premiums.
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It has also been proposed that insurers should file marketing material to the IRA for approval along with the benefit design approval. The material should be simple for consumers to understand and signed off by a senior manager or a person with the appropriate authority to whom the responsibility has been delegated.
Other proposals in the document include establishing an independent accreditation body to carry out the accreditation process of all healthcare providers in the industry with the engagement of all other provider bodies in the industry such as the Kenyan Medical Practitioners and Dentists Council, clinical officers council, the nursing council of Kenya, pharmacy and poisons board and Ministry of Health.
Medical insurance contributes the largest pie in general insurance business premium at 34.5 per cent according to the 2021 second quarter statistics where general insurance premiums amounted to Sh85.36 billion.
Healthcare in Kenya is financed by a combination of direct government expenditure, contributions to the NHIF and private health insurance, with the government being the main funder.
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