GYN CHRONICLES
On Doctors Fees And
Universal Healthcare (UHC)
Dr. Maureen Owiti
economy?
In my understanding Universal Health
Coverage is about Government ensuring
that all it’s citizens have access to quality
health care. In that scheme it ensures
that the vulnerable who unfortunately in
this country are the majority have access
to health care. In the Kenyan model we
have opted to run public health facilities
that range from dispensaries to National
referral hospitals like Kenyatta National
Hospital.
In terms of health financing currently
NHIF collects contributions on a monthly
basis from its citizenry. These funds are
then paid to health facilities based on
category and work done.
D
ecember 2018 and January 2019
were months of social activism
that saw Doctors being bulldozed
once again to reduce their fees all in the
name of Universal Health Coverage
(UHC).
The initial push came from the chair of the
parliamentary health committee herself
honorable Sabina Chege, when she tabled
in Parliament a motion to reduce Doctors
professional fees back to the 2006 rates. I
found this very amusing as the same MPs
had just increased their wages; I don’t
know why they didn’t table a motion to
revisit their salaries and reduce to what it
was back in 2006.
In their submission MPs were looking
after the interest of Wanjiku, who only
has access to a dispensary or health
center near her that may or may not be
functioning. Instead of making Wanjiku
pay private doctors, what is the honorable
member and her committee doing to
ensure that Wanjiku is able to get quality
health care near her because that is where
the crux of the matter is?
If indeed Wanjiku is able to feel confident
in the services she receives in the public
health facility then there will be no need
whatsoever to visit a private doctor. In
such a scenario the private doctor may
have to offer something extra to entice
If indeed Wanjiku is able to feel confident
in the services she receives in the public
health facility then there will be no need
whatsoever to visit a private doctor. In
such a scenario the private doctor may
have to offer something extra to entice
Wanjiku to come for their services by way
of only offering services not available in
the public hospitals or by reducing their
fees. Market forces will dictate what the
doctor can charge.
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Wanjiku to come for their services by way
of only offering services not available in
the public hospitals or by reducing their
fees. Market forces will dictate what the
doctor can charge.
What came next was that various
professional societies and some doctors
were invited to a meeting whose agenda
was primarily to rubber stamp a board
decision to reduce fees. Majority of the
practitioners did not buy the rationale
of reducing the fees considering that the
current rates were for 2016 and needed
adjustment upwards in line with inflation
rates, but finally the board had its way and
a decision to reduce the fees by 20% was
reached.
Subsequently an external stakeholder
meeting was called for and grapevine had
it that COFEK had organized hecklers
to embarrass doctors hence most doctors
kept away from that meeting. The board
took views from the external stakeholders
and based on all views from both external
and internal stakeholders it was finally
agreed to reduce the fees by 20%.
A number of things in this country
have been seriously mismanaged and
one of them is certainly the relationship
between doctors and the public. The main
argument used to reduce the doctors’ fees
was to facilitate UHC. What we would
like to know is what does UHC have to
do with professional fees rendered. Is the
state then saying that we no longer live
in a democratic country and have a free
The sad part on the current state of affairs
is that private hospitals are paid yet public
institutions are starved of funds as NHIF
at the time of writing this article owed
The Kenyatta National Hospital (KNH)
over KES. 800 million, puncturing the
hospitals capability to buy drugs and
essential materials required to run it’s
basic services.
I am fortunate to belong to some groups
that include non-medics and one of the
issues that arose was that the middle class
were very happy with the fact that they
could now utilize what they were paying
as NHIF deductions. will increase premiums yet they are saving
millions and this benefit has not been
transferred to their client’s.
While I am not against this and it should
be the standard, the issue is where are
these funds going? These funds are being
utilized to enrich private facilities and
insurance companies because what has
happened? NHIF will now give a certain
amount towards surgeries in private
facilities. The real situation is that the same surgery
done in a public facility will only be
charged Kshs. 10,0000 in a District
hospital. The total hospital bill may
come to about 15,000. In this way public
hospitals are not making any money.
Just an example: I’m a Gynaecogist
and should a private patient require a
hysterectomy (removal of uterus) then
NHIF will issue a pre-authorization to
pay between KSHs 80,000 - 130,000 and
the patient will top up the difference.
Most insurance companies will now insist
that they will not pay until you have a
letter of undertaking from NHIF. This
was standard as initially it used to be that
NHIF would pay only 2000/- per day bed
stay and this had to be paid by the patient
if they did not have NHIF. The hospital
will be paid for total bill by both NHIF
and the insurance company or the patient.
For the insurance company this results in
a huge saving.
Meanwhile Insurance companies insist
that if doctors’ fees are not reduced they
My suggestion would be the rebate be
standard e.g. 130,000/= and this should
only be paid if the patient is accessing
care in public health facilities and NHIF
should be mandated to pay within a
month of receiving the invoice. In this way
public hospitals will collect adequate cash
to invest in infrastructure development so
that even the so called middle class may
now seek care in public hospitals.
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and
fertility consultant based in
Nairobi. You can commune with
her on this or related matters via
email at: Drmaureenowiti@gmail.
com.