Richard Kerich, CPA, MBA Chief Executive Officer National Hospital Insurance Fund-Kenya

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1 Richard Kerich, CPA, MBA Chief Executive Officer National Hospital Insurance Fund-Kenya

2 Country Overview Key Statistics: Total Population: 40 Million Gross National Income per capita: $ 1,620 Life Expectancy at Birth m/f : 58 /62 Probability of dying under 5: 84 per 1,000 Probability of dying between 15-60yrs(m/f): 358/282 per 1,000 THE per capita: $ 68 THE as a % of GDP: 4.4% Out of Pocket Expenditure: 39% % of population in the rural areas: 67% % of population under the international poverty line: 19% 2

3 Landscape of Health Coverage by Sector Population Size (principal +Dependants) Public Service 2.8 Million (Adults - 0.8M) Private Sector 4.4 Million (Adults 1.1) Informal Sector 26 Million (Adults 11M Basic Cover NHIF NHIF NHIF / OOP / Private Top up Cover Company Insurance / Schemes / CBHI Ex-gratia Coverage by NHIF Coverage by other Schemes 100% 98% 8.75% n/a <1% 1% <1% n/a Indigents 7.8 Million (Adults- 1.6M) Government 3

4 Policy Decisions for Informal Sector Subject to the NHIF Act, any person Who is resident in Kenya Who has attained the age of 18 years; and Whose total income whether from salaried or selfemployment, in the immediate preceding month was not less than KES 1,000 ($11) Premiums payable to NHIF (Currently at USD 2 p.m.) Family based membership, no age limit, no exclusions Coverage is compulsory but yet to be enforced due to political, logistical and social factors. 4

5 Operationalising Coverage to the Informal Sector The operating definition of informal sector workers are those in gainful employment without regular wages: -farmers, fishermen, hawkers, small vendors The NHIF Act was amended in 1972 to include the informal sector. Aggressive recruitment campaigns started in 2006 when coverage was was <1% (56,000) to the current levels of 8.75% (680,000) The most effective awareness method is Below-The- Line (BTL) strategies road shows, Vernacular FM Stations, door-to-door campaigns, Barazas etc Personal confession by members on benefits is equally effective. 5

6 Operationalising Coverage to the Informal Sector Cont d Several initiatives have been made to include the informal sector: Unambiguous contributory rate. Affordable rate of $ 2 (Kshs 160 pm) Partnerships:- Group enrollment SACCOs, FOSA, Cooperative Societies, Matatu Association, Churches, Mosques etc Private Insurance for complementary products 6

7 Operationalising Coverage to the Informal Sector Cont d Leveraging technology: - M-PESA (Informal Sector and SMEs) EFT and Direct Banking (Formal Sector) Scratch Card (Informal sector penetration) POS for surveillance, claims notification and tracking. 7

8 Structure of the formal vs informal sector number, millions informal formal 8

9 Impact of Legacy Systems on the expanding coverage to the informal sector Much as the Informal sector has grown exponentially, expanding coverage to the informal sector has been a hampered by lacy issues: - Partial implementation of the NHIF Act. Inpatient Compulsory membership for informal sector. Poor health planning Human Resource (Production, Deployments and Retention) Infrastructure (Spread, Upgrades and Maintenances) Medicines and Commodities Health Financing Policies Governance 9

10 Impact of Legacy Systems on the expanding coverage to the informal sector Cont d Low awareness because NHIF is a statutory scheme. Low cash circulation in the informal sector economy. 10

11 Impact of Legacy Systems on the expanding coverage to the informal sector Cont d Access/use of financial services % of population MFIS Post banks SACCOS Banks Informal Groups Unserved 11

12 Impact of Legacy Systems on the expanding coverage to the informal sector Cont d Commercial insurers have largely stayed away from the low-income market. With the single pool, a cross-subsidy exists from the formal to the informal, from high earners to low earners 12

13 Challenges Lack of effective assessment of incomes due to variability in earnings High opportunity cost on Insurance premium. Unaffordable premiums High Transactional costs, Cultural barriers Asymmetrical information on the informal sector(adverse selection) 13

14 Challenges Unfavourable history with HMOs (MIP). High rate of failure in the 1990s Benefit packages cover only inpatient. Member registration and identification Inconveniencing contribution collection system, Long and time wasting member registration and identification procedures. 14

15 Successes, goals and Priorities NHIF has managed to increase its membership from < 1% in 2005 to 8.75% currently mainly through group enrolment The interests of Health providers and NHIF are almost aligned. 90% health Providers satisfaction, 78% member satisfaction, and 65% staff satisfaction. Ability to adopt with new technologies 15

16 Deliberate penetration of informal sector Registration Benefits Premiums Linking Kenya National Registration Bureau, NSSF and registrar of Companies to NHIF. Technological leveraging Social Protection for the indigents 16

17 Asanteni sana 17

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