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A tug of war is shaping up between insurance companies and doctors over the 20 per cent reduction order on medical fees and charges by the government.
Doctors have demanded that insurance companies reduce their premium by 20 per cent before they implement the reduction order by the Ministry of Health.
Earlier, the insurance companies had threatened to increase their premiums if medical fees and charges by the doctors were not reduced.
A premium is an amount an individual or a business pays for an insurance policy. Once it is paid, the insurer must provide coverage for claims made against the policy.
However, as the implementer of the order, the Ministry of Health is torn between who to support between the two parties, leaving ordinary Kenyans at the mercy of the two.
“Some people are thinking that doctors will suffer; we are not going to suffer. However, the worst will be that we risk losing Kenyans who cannot see a specialist unless in a public hospital and cannot pay for insurance. We are joking with the lives of Kenyans,” said the secretary-general of Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU) on Saturday.
The doctors demanded that the insurance company pays for services given by a specialist doctor within 30 days from the date rendered.
The doctors noted that if the costs charged by the professionals are to be reviewed as proposed in the fee guidelines, then the premium has to be reduced since it is the main reason why health is costly in the country.
“The reason healthcare is costly is because the insurance companies are taking longer to remit money for the services that have been rendered yet they are immediately deducting a huge amount of money,” said Dr Ouma Oluga. He added that specialists should directly invoice the payer (patient) or the insurance companies for services rendered in order to reduce the amount of time taken to pay for services. Further, the time to pay should not exceed 30 days,” said Dr Oluga.
The doctors also called upon the insurance companies to immediately disband panels since they comprise persons without any medical background and some of them are corrupt.
“Insurance companies are delaying care to patients, they dictate which hospitals the patients can seek services from without taking into consideration the patients’ needs and choices,” Dr Oluga said.
They alleged that the doctors are owed over Sh700 million accumulated in the last two years.
“Why would I render services and get paid after two years yet the patient is being deducted immediately the services are offered. We will endeavour to recover from the insurance companies all the monies that are owed to us,” he said.
The insurance companies, during an earlier public consultation forum organised by the Consumers Federation of Kenya, said if the fees charged by doctors were not revised downwards, they would increase the premiums.
“The sector is already bleeding from the high costs of healthcare. Given the small number of insured Kenyans, we might soon have to increase our rates,” Ms Jemimah Mbugua of Resolution Insurance said.
“Only about three per cent of Kenyans have medical cover other than the National Hospital Insurance Fund. The doctor’s fees in its current form will put insurance out of reach for many,” she said.
If adopted, the minimum consultation fees charged by a general practitioner will drop from Sh1,800 to Sh1,440 while the maximum fees will reduce from Sh5,000 to Sh4,000.
Similarly, the minimum consultation fees charged by a specialist doctor will go down to Sh2,980 from Sh3,600, while the maximum from Sh7 500 to Sh6,000. The board is recommending a minimum of Sh29,800, down from Sh36,000, for normal childbirth, while the maximum drops from Sh72,000 to Sh57,000.
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