The multi-billion-shilling medical insurance scheme for teachers is on the spotlight over poor service, including cases of inaccessibility, bureaucracy and corruption, and failing to solve the problems it was meant to.
While teachers who spoke to the Nation expressed dissatisfaction with the scheme, some service providers spoke of strained relations with Minet Kenya, the insurance brokers who administer the scheme.
Financed by the Teachers Service Commission (TSC), the scheme that has been running for six years is the largest in the country, covering 334,531 teachers and their 734,372 dependants as at July this year. The commission collects more than Sh6 billion shillings from teachers in premiums and gets Sh3 billion more from the government towards the scheme.
In parts of central Kenya, some hospitals are reported to have declined to provide services after Minet Kenya defaulted on payments from April.
Read: Teacher transferred for demanding change of medical insurance scheme
“We are experiencing a strained relationship with teachers because there is a limit to which private business can bend backwards to accommodate debt. In the case of teachers, there is non-payment and breach of contractual terms,” said private health care service providers lobby chairperson Kenneth Maguta.
Mr Maguta – who runs The Virgin Hospital in Murang’a – said unless the insurance scheme managers revisit the contractual commitments, many hospitals will be forced to require teachers to pay for treatment. He said key among the complaints is the scheme refusing to honour payments, discriminating beneficiaries and failing to engage providers to address the conflict.
Pending bills
“As things stand now, we are contemplating going to court so that we can have our pending bills paid and seek judicial consideration that we be absolved of blame should we turn away teachers seeking treatment on the strength of the health scheme since it amounts to obtaining services by false pretence,” he said.
In an interview with the Nation, Minet’s representative in central region Lydiah Macharia said: “We have been receiving feedback but not to an extent of treating it as a full-blown crisis… Some complaints can be addressed administratively while others need a stakeholders’ meeting.”
A teacher from Meru County who spoke on condition of anonymity said the medical scheme was unhelpful, especially the outpatient cover. According to the teacher, the cover comes with a dismal daily spending limit, making it impossible to access quality healthcare. “The hospitals are forced to prescribe generic medicines or else you pay in cash,” she said.
The teacher lamented that the cover also comes with a limitation where a teacher or their dependants cannot use the insurance before seven days elapse after a previous treatment.
“In case you do not recover and need further treatment, you will have to wait for seven days before you spend against the medical cover. This is quite frustrating,” the teacher said.
Mr Karuti Nchebere, the Meru County executive secretary of the Kenya Union of Post-Primary Education Teachers (Kuppet) said while the services under the cover have improved, there is need to increase the number of service providers.
In Nyeri County, teachers said they were dissatisfied with the quality of services. The cover allows teachers to visit only two medical facilities within Nyeri town, which they said lacked many services.
“When you are sick and they cannot treat you, they refer you to the major hospitals, but the referral process is hectic and takes a lot of time,” one teacher said.
“They should increase the number of hospitals we can visit. They should also speed up the referral process,” another teacher said.
Medical scheme
Teachers in Nakuru County described their medical scheme as a “scam” that does not serve their interests. Some of the teachers who spoke to the Nation called on TSC to overhaul the scheme.
“Using this scheme has been frustrating and humiliating,” said a secondary school teacher from Molo sub-county who only gave his name as John for fear of reprisal. He criticised the one visit per week rule for out-patient treatment.
He added: “Some of the hospitals that offer optical services in Nakuru town are a mockery. Some are known to inflate the bills and this has seen teachers receive many letters from National Hospital Insurance Fund (NHIF) and TSC to explain why the bills are so high,” he said. His colleague from Subukia said some hospitals prescribe generic drugs to teachers, saying original drugs were not covered.
Teachers in western and Nyanza regions also expressed disappointment with the quality of medical services at designated facilities.
In Kakamega County, teachers called for the scrapping of the Sh1,200 and Sh1,500 fee they pay per visit when seeking outpatient services, and complained about the pre-authorisation requirement for specialised services.
“Our teachers are suffering because of the capitation, which limits how much they can spend per visit,” said Mr Harrison Otota, the executive secretary of Kuppet in the county.
In Homa Bay County, teachers called on their employer to involve them when selecting service providers. The county Kenya Nation Union of Teachers (Knut) secretary Patrick Were said: “Sometimes, teachers take up to one week to be discharged from hospital because the insurance provider has a slow approval system.”
Samburu County Kuppet executive secretary William Lenkuyia said teachers had difficulties getting services ” in volatile areas of Samburu North and East. Other hospitals are not in good condition.”
Minet Kenya did not respond to an email by the Daily Nation seeking a comment.
Reporting by Mwangi Muiruri, David Muchui, Regina Kinogu, Francis Mureithi, Benson Amadala, George Odiwuor, Elizabeth Ojina and Geoffrey Ondieki