NHIF Building [Photo/kenyamanual.co.ke]

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A cloud of mystery is surrounding what informed last week’s decision by National Health Insurance Fund (NHIF) to cut down the number of outpatient visits beneficiaries can make to four annually.

Although Health Cabinet Secretary Cleopa Mailu quashed the move on Saturday by the State-owned health insurer, the announcement raises questions about whether all is well at the Medicare insurer.

Sitting at the same table in the press conference where NHIF chief executive officer Geoffrey Mwangi announced the changes last Thursday, Kenya Association of Private Hospitals Treasurer, Dr. Timothy Olweny, welcomed the changes without endorsing them.

“I think for us, we will work with the changes, but what we would first want to know are the implications they would have for care to members,” said Olweny. 

An online petition later and social media outrage from Kenyans following the changes forced Mailu to move swiftly and salvage the situation by suspending the NHIF directive.

In spite of the intervention, the intention to cap hospital visits has raised hard questions. 

Why did the Fund conceive the changes at a time when the national government is keen to ensure that all Kenyans have access to quality medicare? 

Were the changes informed by possible liquidity problems which could explain the need to limit hospital visits?

Or is it that officials at the Fund wanted to run it like a commercial insurance firm which is more keen to post a profit?

Has the Fund taken more risk at lower premiums than it can cover? 

The most recent publicly available financial report of the Fund shows a healthy organization meeting its obligations with members’ contributions and retaining a handsome surplus at the end of the year.

In a financial statement for 2014/15 audited by the Auditor General, the Fund reported a Sh2.6 billion net surplus after paying Sh5.8 billion in benefit claims from Sh13.28 billion in revenues. 

The financial report for 2015/16 is not available to the public but statements by its top managers have pointed an even rosier picture of the state of affairs.