Tuesday, April 26, 2005

Medical Insurance Crisis

Many insurance companies are refusing the opportunity to provide medical insurance for some huge state corporations: Why? Because of fraud and abuse of the system. Other providers such as Madison and UAP are not taking new clients, but will continue to service their previous customers. In past years, some insurance companies received premiums of over 100 million shillings for the year, only to realise that this amount has been exhausted within six months. They have now become vigilant and examine each cost item and refuse to pay for frivolous or fraudulent cases.

This is because the doctors and lawyers have colluded with staff of these corporations and come up with fraudulent costs that have been submitted for payment. Members of staff have given membership cards to relatives/friends to use. Once a hospital knows you’re a senior official covered by the government, they will often recommend their own doctors who will ask for a whole battery of unnecessary tests and operations and observation by other “specialist doctors ” who are hurriedly summoned by the hospital to attend to a very important patient. These doctors then all invoice the medical service provider at their own rates.

Parliament’s next multi-million scam
According to the East African, members of parliament will now have expanded medical coverage for two wives/spouses and eight children (up from 4) from a joint package by insurer's AON Minet & ICEA who will receive Kshs. 32 million a year in premiums from the National Assembly. Other bidders were Madison (33m) Great Five (66m) and Jubilee (75). The previous provided AAR, which covered all 222 MP’s for 32 million last year (and says it lost 8 m) now wanted 92 million shillings. Don’t be surprised if AON/ICEA come crying after 3 months saying MP’s have exhausted their premiums because the package provides that an MP can be admitted to any hospital in the world as long as it is recommended by their doctor for specilaised treatment. Since the scheme is not contributory, you can expect the insurers to come and ask Kenyan taxpayers to top up the MP’s medical pool.

New thought on NSHIS
I have been opposed to the new medical scheme (Ngilu’s NSHIS) because it’s an extra huge tax out or my pocket and it gives me less coverage than I already have. However doctors are vehemently opposed to the new scheme because their costs will be controlled. Right now they can invoice whatever they want to the National Hospital Insurance Fund.

A medical insider told me that in the long run, the only two insurer's will survive, AAR and Resolution. AAR - because they control a great percentage of costs by having their own clinics, generic drugs and also have their own doctors who are the only ones authorized to allow patients to be operated on.

1 comment:

Blue Cross of California said...

Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.


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