State-backed health insurer, National Hospital Insurance Fund (NHIF), last week announced plans to more than double workers' monthly contributions to the fund, which were last revised in 1988.

The fund reckons that the additional financial muscle would enable it roll out a raft of products such outpatient services and increase the amount of rebates -- the amount it pays to hospitals on behalf of its members.

This is set to ease the burden on NHIF members who continue to pay a huge fraction of their hospital bills driven by the rising cost of medical services.The public health insurer pays a daily rebate of between Sh400 and Sh2, 400, considered inadequate given the current medical costs.

Salaried workers' contributions to the National Hospital Insurance Fund (NHIF) range from Sh30 to Sh320 based on the gross monthly salary that is capped at Sh15,000, which the fund says is out of step with the current salary levels.

Business Daily caught up with policymakers, hospital administrators and contributors on the impact of the increment on the access to health care.

Mr Steve Kerich, CEO, NHIF

"The current premium scale was introduced in 1988, when the PS salary was Sh5,000, therefore, it has become outdated and the management is doing a review on the premium level to be in tandem with the current salary scale and the cost of health care.

Since 1988, the maximum benefits payable to hospitals on behalf of contributors have more than tripled, this has made it very difficult for introduction of new products such as outpatient services and offer higher rebates to hospitals.

Going forward, we should be able to meet the costs of all medical conditions without exceptions including conditions such as open heart surgery where a member currently co-pays.

Dr Cleopa Mailu, CEO, Nairobi Hospital

"I don't think the move by NHIF to increase the monthly premiums will make a difference to the people who matter, especially those in the rural areas.

This will only allow the fund to continue stashing money in their accounts which do not help the needy. They have left their core job and are busy constructing office blocks, buying ambulances and land, and I don't see this stopping.

The bottom line is that the additional financial resources will only help enhance efficiencies at NHIF. (The fund receives Sh5.3 billion in premiums and pays Sh2.8 billion to hospitals)

If the government is keen on providing quality healthcare to the needy, it should start a social health care scheme from scratch and improve health facilities across the country, since insurance without facilities doesn't help.

For NHIF, it should be opened to competition and its selling point must be its products and not gaining members through forced taxation. We are trying to mix the social aspect of health cover and private insurance, the two can't work together.

Ashok Shah, chief executive officer, APA Insurance

"It's the right move, but the playing field has to be level.

We don't fear competition, but contributors should be allowed to choose between the private players and NHIF.

But if the current structure remains where employees have no choice, but to be members of the Fund, there is a problem of undue advantage.

At the moment, NHIF is not a direct competitor to private health insurance providers since the fund's scope is very limited.

It only pays for bed night in some private hospitals, yet we offer comprehensive medical cover including outpatient services. This is a market structure that allows NHIF and private insurance firms to complement each other.

But if NHIF is increasing its premiums to allow its offer comprehensive cover, then I am seeing a competitor and a major one since some of our clients are likely to drop their private covers for the cheaper state-backed cover.

James ole Kiyiapi, Permanent secretary Ministry of Medical Services

"We are reviewing the rates and this will be pegged on income levels that will not be capped.

But the key issue here is not the price of the premiums, but giving NHIF capacity to offer universal health coverage that will provide quality and affordable healthcare to the entire population.

Currently, more than 11 million adults and their dependants, especially in the informal sector, have no health insurance cover leaving a large proportion of them going without access to healthcare services.

This segment of the population requires our collective and concerted effort to bring them on board, and this makes the roll out of comprehensive health cover a priority.

This requires money, and those earning more than Sh15, 000 should sacrifice and pay a little more.Treasury and development partners will also chip in.

Annabel Karanja,

NHIF contributor and MD, Afri Business Development

"I would not mind the increase if it leads to NHIF paying a bigger portion or the entire hospital bill and they start to offer outpatient services.

But if the increase in contributions does not translate to enhanced services it would be unfair for workers, especially under the tough economic conditions. The last time I was admitted to hospital, NHIF only met 20 per cent of the bill, and this has since forced me to take a private insurance cover to supplement with NHIF.

It's a wait and see approach at the moment, but I may decide to drop the private insurance cover if the fund enhances its coverage.