NHIF Terminates Capitation Contract With National Spinal Injury Referral Hospital

NHIF Member Management Review

The National Health Insurance Fund (NHIF) has announced that it will be terminating its capitation contract at the national spinal injury referral hospital. Owned by the Ministry of Health, the National Spinal Injury Hospital, the only one of its Kind publicly owned, makes part of the five current health facilities including, Kenyatta National Hospital, Moi Teaching, and Referral.

“NHIF wishes to inform you that as of 1st January 2020, we shall no longer have a capitation contract with the above-mentioned facility. Members who had selected should, therefore, be advised to choose any other available preferred healthcare facility immediately,” read a public notice from NHIF official twitter handle.

A capitated contract is said to be a healthcare plan that allows payment of a flat fee for each patient it covers. In a capitated contract, a managed care organization pays a fixed amount of money for its members to the health care provider and is sometimes referred to as capitation agreements.

Under such agreements, the healthcare provider is paid a stipulated amount per month to see patients regardless of how many treatments or the number of times the physician or clinic sees the patient.

The agreement is that the healthcare provider will get a flat, prearranged payment in advance per month and whether or not the patient needs services in a particular month, the provider will still get paid the same fee and the more treatment a patient needs, the less money a health provider makes per treatment.

With the scrapping of the capitation contract come 2020, patients with spinal code conditions will have to part with expensive sums of money to get treatment, a financial commitment that could completely drain their resources.