Reference is made to the invitation extended to us by the Senate Standing Committee on Education in respect of this topic.
When we received this invitation, we were at a loss as to why KUPPET was being invited to address this sitting of the House. The scheme is provided under a contract between the Teachers Service Commission and Minet. While we obviously have our views about the services offered by Minet under the contract, we have no structural methods of addressing the same.
As my Honourable Senators are aware, medical insurance is a big concern for working people globally. In the Western world, in countries without universal cover, insurers have devised ways of out-of-pocket costs and deductibles, which raise the cost of healthcare. The high costs have left millions of people uninsured or underinsured, while others are trapped in a vicious cycle of medical debt.
I would challenge Senators to use your good offices and explore the means by which Kenya can attain universal health coverage that guarantees access to affordable, high quality healthcare services for all Kenyans.
Having said that, it is important to appreciate complaints from teachers on matters affecting their health services. The reported cases are dealt with on ad hoc basis, since, as aforesaid, we have no systemic means of verifying the origin or extent of the challenges complained of.
Before I delve into the specific issues raised, let me inform the committee that the teachers’ medical cover is a highly-valued product by our members. Its introduction came after years of struggle. We take our members’ concerns about the quality of services very seriously. We are currently fighting to improve the governance of the scheme, as will be shown later.
On the specific questions raised, KUPPET’s views are as hereunder:
The scheme uses a capitation model and every hospital approved under it is mandated to provide services within its capitation limits. As we understand it, the amount paid by Minet to hospitals varies with the service level and capacities of the different service providers. Definitely, the capitation amount for a facility with advanced services, such as radiology or ultrasound, is higher than for clinics providing basic care. A facility having specialists or Medical Officers is paid much higher than those run by Clinical Officers.
Regarding the limits for teachers, this is based on Job Groups. Our members know that we have no authority on this tabulation, hence their using different means to air their grievances, including through Senators like has happened in this case.
The union has recommended to the TSC and Minet that the capitation levels be reviewed annually, based on customer feedback, the level of services on offer by facility and prevailing economic conditions in the country, among other factors.
- RESTRICTIONS ON HOSPITALS TO VISIT
According to the information we have, Minet has a list of about 500 service providers throughout the country. Some of these facilities, especially the referral hospitals, require referral letters before a member can be served.
Regarding hospitals that may be ill-equipped, that would be gross negligence of duty by both the insurer and the government departments that license and accredit health facilities. As a union, we expect that the facilities accredited to treat our members be fully licensed, have qualified personnel, be equipped with the necessary technology and stocked with the right drugs.
The criteria of accrediting facilities used by the insurer should be shared with stakeholders including the unions. The system should provide for continuous oversight to weed out service providers that do not meet the set standards. Likewise, the system for cancelling contracts and on-boarding of new facilities should be seamless to avoid any time lapses.
- DELAYS IN APPROVAL
We have received some complaints of delays in the approval of referral services. Outpatient services are accessed without pre-authorisation since they fall within the capitation amount. In cases of referrals, the service provider should establish a 24-hour contact centre to authorise cases. However, these cases have been handled effectively.
- CHALLENGES IN SERVICE PROVISION
We received similar complaints from some members in the recent month when the government delayed in remitting funds to the scheme. When Minet did not provide payments to service providers, some of them stopped providing any services on the basis that the scheme was one of their major clients. The hitch with payments, therefore, affected their operations significantly.
- RIGID OPERATING HOURS FOR OUTPATIENT SERVICES
We have received complaints that some health facilities accredited under the scheme do not operate at night. This problem arises from the inadequate healthcare infrastructure in the country, especially in rural or marginalised areas. To mitigate this problem, we advise teachers to seek services in alternative hospitals in their jurisdictions that operate on 24-hr basis.
- LIMITED DENTAL SERVICES
The union has not received any complaints in this regard. As we know, the scheme covers for all dental services including consultation, tests, surgeries, root canal extraction, and others.
- RECOMMENDED SOLUTIONS
As a union, we want the scheme to be strengthened through more budgetary allocation. Our Memorandum of Demands for the next round of the Collective Bargaining Agreement gave indicators as to what would be reasonable coverage.
As I said at the beginning, teachers value this medical scheme. Beside catering for their hospitalisation bills, the cover has provided families with a proper life cover of Sh1 million and last expense cover of Sh600,000 for the lowest paid teacher. These provisions have ended an era where teachers were holding harambees for medical and funeral bills almost on a weekly basis.
Thanks to the advocacy of our unions and the TSC’s financial provision, this scheme is one of a few insurers in Kenya that cater for COVID-19-related hospitalisation. Our efforts, therefore, aim at strengthening the scheme to improve the quality of services it will offer to our members.
In this regard, KUPPET has proposed to the TSC that the administration of the scheme should be open to stakeholders, including the unions. Whereas there are County Governance Committees on the Medical Scheme in the counties, we have pushed for the formation of a National Governance Committee on the Medical Scheme comprising of the stakeholders. The county committees have a limited mandate of monitoring operations. A National Committee that we propose would address the identified weaknesses at a structural level and improve the scheme.
KUPPET also proposes to the TSC to bridge the communication gap on the scheme by investing in Information, Education and Communication (IEC) to ensure that information on the cover flows to all staffrooms in the country.
We thank the Senate for according us the time to share these views.
AKELO M.T. MISORI,