Taifa Care: Watch out! Don't shoot yourself in the foot

I stumbled on two interviews involving Prof. Paul Krugman, a Nobel Price Laureate in Economics, regarding Zombie ideas. As the name suggests, Zombie ideas are just that –dead but revived by interest groups.

The Professor mentioned a few Zombie ideas including Universal Health Care (Obama care) in the US which was opposed as unworkable but which has provided health care for an additional 20 million Americans.

 This one struck a chord with me given the noise against Taifa Care in Kenya.  This is a health insurance plan designed to provide UHC to a greater proportion of Kenyans. Its an upgrade of the age-old NHIF which provided limited health care insurance. But it is facing sustained opposition from some Kenyans.

Although data shows that the uptake is positive, having registered an estimated 18.2 million Kenyans,  compared to nearly 4.6 million under NHIF, the opposition, which is a zombie idea,  still persists. Yet if numbers were a measure of popularity, then SHA/SHIF is, far popular than NHIF.

According to the SHA website, the scheme contracts health facilities to provide health care by referral from primary health facilities. “By Referral from health care facilities”, that, is the elephant in the room. In my simple understanding, no health facility can launch a claim on SHA without proof of referral by a primary health facility- the Dispensaries, health Centres, and level 4 hospitals.

The SHA system includes health Information Exchange system which allows seamless sharing of patient records among health Facilities. It includes Client Registry, Heath care Provider Registry, and Health facility Registry. While such a system upgrades efficiency and continuity in health care, it weeds out fraud.

In an interview with TV47 towards the end of last year, the Chief Cabinet Secretary, Musalia Mudavadi, said that the Opposition to SHA is driven by some health facilities that had turned its predecessor, NHIF,  into a milking cow. There were hospitals with “ more Accountants than Doctors, whose work was to manipulate papers to claim payment from NHIF for no services rendered,” he said.

The SHIF/SHA  is a health care insurance cover that, like all other covers, pools resources to finance health care for Kenyans under the Universal Health Care policy. Every Kenya over 18 is expected to register in, and contribute to, the scheme according to their financial ability. The idea is to ensure that every Kenyan receives quality and affordable health care without breaking the bank.

Its predecessor, NHIF, didn’t provide such comprehensive cover which is why some people were not eligible or the cover was insufficient. Some ailments were not covered which forced some patients to foot medical bills from their pockets, causing destitution in some instances.  SHIF/SHA is designed to protect Kenyans from destitution if they fall sick. But they have to pay and update their premiums.

The trouble for the health care insurance premium is, it is presented as a tax by opposers which, it is not. Its transparency has rattled a few people who are apparently, benefitted from the fraud and corruption inherent in NHIF. They earned for supplying nothing. Some Hospitals forced patients to undergo unnecessary surgeries some of which turned tragic.

And these are the people behind the opposition to the four - month old scheme which has registered more users than its 60 year- old predecessor.

Given the potential benefits of the health cover, Kenyan allowing themselves to be hoodwinked by persistent criticism, could be shooting themselves. The story is told one critic, what someone christened "Keyboard Mercenaries" who fell sick. At the hospital, She was told that the treatment would cost her some Kshs 250,000 since she was not registered with the cover.

Jolted to reality she registered and paid all the outstanding installments, some Kshs 8000. SHA approved her and she was treated for Kshs 8000, in the process,  saving a huge KES 242,000. She has not spoken about it. She was about to shoot herself in the foot and was encouraging others to do the same. Watch out, we could be shooting ourselves in the foot!