31 July 2008
A few years ago in the US, a man was accused of throwing his seriously ill wife from the balcony because he could not afford to pay for her medical care.
The woman died as she fell down a four-storey building.
Though the act was extreme in nature, many Kenyans often find themselves in such difficult situations due to inability to afford medical bills and many have painfully and helplessly watched as the worst happened to their sick, for failure of funds to get them treatment.
These problems have been fuelled by the fact that access to medical covers has for long been a nightmare to many, with available medical schemes being too expensive, thus locking out many.
Because of this, many people have had to rely on government medical subsidies, which in some cases do not come in handy when a problem strikes. However, access to cover is likely to increase as micro-finance and insurance companies find a niche in the informal sector to launch new products.
In a bid to help the poor women in society access medical care, Kenya Women Finance Trust (KWFT), launched a medical insurance cover that costs as low as Sh10 per day or Sh3,600 per year and underwrites all in-patient expenses for a member’s entire family, with no exclusion clauses for chronic illnesses and maternity. Surgery costs above Sh15,000 are also covered
Women entrepreneurs
The cover targets the organisation’s members who comprise of women entrepreneurs running small and medium-size businesses.
The only restrictions are that the expenses be incurred in appointed private, public and mission hospitals for up to 180 days.
The premiums are seen as affordable to the target group, whose small businesses earn about Sh150 per day and who service loans from KWFT starting at Sh20,000. NHIF runs an alternative scheme at premiums of between Sh30 and Sh230 per month, under which 1.8 million Kenyans fall.
Proponents of the KWFT scheme say its strength lies in giving women the opportunity to tackle family health needs.
“It is a major empowerment tool for women. They will have control over their health spending,” said Dr Jennifer Riria, the chief executive of KWFT.
Most group health care premiums covering up to four members of a family average between Sh750 and Sh1,000 per month. They cover people earning above Sh30,000 per month, a group that falls under the lower-middle and middle-income groups.
KWFT Afya card, the three-in-one insurance policy takes care of in-patient, personal accident and last respect expenses.
Dr Jennifer Riria says the comprehensive family medical cover will enable its clients look after their families’ health on a sustainable basis.
The medical cover is made possible due to a partnership between KWFT, Co-operative Insurance Company of Kenya (CIC) and the National Hospital Insurance Fund (NHIF).
“This is a milestone for KWFT as we do not only serve our clients through access to finance, but also pay great attention to credit plus services that empower and address other family concerns in their daily lives,” she says.
Already 4,227 clients are currently covered and the micro-finance institution plans to increase the number of families covered to 60,000 by end of the year.
Ms Riria says so far, Sh14 million has been used to finance the Afya Card cover for KWFT clients. This is a countrywide medical scheme offered through KWFT’s 123 field offices.
Less than 100,000 people are covered by micro-health insurers compared to those in Namibia where it accounts for between 20 and 30 per cent of health care expenditure.
But the KWFT model will need to learn from the weaknesses of a similar arrangement started in 2005 through a trio partnership involving K-Rep Bank, AAR Health Services and the UK’s Department for International Development (DFID).
In addition to the Afya card, KWFT has other non-financial services that include, LPG Gas, Solar Systems, Simu ya Jamii and water tanks for water harvesting solutions.
The micro-finance institution, one of the largest in the country mainly provides its financial and non-financial services to economically active, low income women entrepreneurs.
It currently has an active client-base of 160,000 and has disbursed Sh1.5 million as at April 2008. “KWFT has the infrastructure and capacity to reach majority of families’ to access affordable health care in the country,” says Dr Riria.
“We believe in low income women as clients, entrepreneurs and change agents and work to build financial systems that work for the majority.”
Biashara loans
Some of the financial services offered by the organisation in which last year it offered Sh6 billion to its members include Biashara loans, Mwangaza loans for mini groups, Mwamba loans for individuals, Start-up loans and Elimu loans.
The slow uptake of medical cover has been blamed on poor pricing due to inadequate data useful for actuaries who come up with the rates.
Insurance experts say higher prices are also due to fraud and lack of standardisation in charges and services.
But this seems to be changing because of a growing middle class and the delay by the government to come up with a better model for universal health care.
AAR Health Services recently launched a medical cover called Cover Me. It offers un-limited out-patient services, which include optical and dental.
The AAR scheme targets the 28 to 40 age bracket, costs Sh50 a day and the company looked to double its revenue to Sh1 billion from the new product.
Resolution Health, another insurer, recently introduced a cover targeting people working in small-and-medium scale businesses. The company said it used the strategy to enter the low-income market.
Only about 500,000 Kenyans are on private health schemes, according to data from the health management industry
Mrs Charity Ngilu suffered a setback when her fight for a mandatory national health insurance scheme when she was health minister was blocked, following widespread condemnation by big businesses and private health insurance providers.
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