Less than a quarter of Kenyans or just 11 million out of about 55 million Kenyan population has some form of health cover.

A new draft survey titled Kenya Medical Comprehensive Report shows a worrying trend in the country’s healthcare cover, despite the growing number of Kenyans enrolled with the National Hospital Insurance Fund (NHIF), at a staggering 90 per cent.

The stark reality, according to drafters of the report heightens the need to quickly advance full development of a Universal Health Coverage (UHC) by the country, in what it is believed will need a regulatory structure.

“The report is the key document that shall be used to develop the regulatory framework on medical insurance and a collaborative framework between the Insurance Regulatory Authority and other stakeholders,” reads the document.

National Treasury

Developed by three actuaries, a consultant all contracted by National Treasury is proposing  to rope in community-based health within the regulatory of the Insurance Regulatory Authority (IRA) as well as licensing and regulating Health Maintenance Organisations as a new license category at the IRA.

In addition, the report proposes that all policyholders should have access to the same policy options and be included in the same risk pool while a prescribed minimum benefits (PMB) package for all health insurers should be implemented.

“There should be provision for regular review and amendment to the PMB package to adjust for changes in affordability and the overall disease burden,” it reads in part.

Corrective measures

It adds that the insurance sector regulator should enforce corrective measures on market players known to set unreasonably low premiums on medical indemnities.

The draft paper further wants to see Kenyan insurance firms file marketing material to the regulator for approval along with the benefit design approval. 

“The material should be simple for consumers to understand and signed off by a senior manager or a person with appropriate authority to whom the responsibility has been delegated,” it recommended.

Other proposals include the establishment of an independent accreditation body to carry out certification process of all healthcare providers.