Private hospitals threaten to boycott NHIF members

Dar es Salaam. Private health facilities are now threatening to stop attending to members of the National Health Insurance Fund (NHIF) in protest at new rates that are expected to take effect in January.

NHIF said earlier this month that it had standardised rates by increasing amounts the government-run insurer pays for some services and medicines and lowering others.

It added that the rates were adjusted to reflect the prevailing situation and that various health stakeholders were involved in the review.

However, the Association of Private Health Facilities in Tanzania (APHFTA) said on Monday that NHIF passed the new rates without involving it, adding that many hospitals would close down due to “huge” losses if the rates would come into effect as planned.

“We think we will not manage to continue serving NHIF members when the new rates come into effect,” APHFTA said in a statement.

“Considering the fact that the rates had not been reviewed in the last seven years, our expectations were to see an increase in health service charges instead of a reduction.”

APHFTA said an increase across the board would have compensated hospitals for payment delays, inflation and the recent drop in the value of the shilling against the US dollar.

According to NHIF, the packages, which indicate services, prices of medicines and fees covered by the fund, were reviewed this year to take into consideration changes that have taken place since 2016 when the last review was conducted.

The fund has maintained that the review was inclusive and involved various key stakeholders, including APHFTA.

“We involved various stakeholders and engagements are still ongoing. The process was open to many stakeholders and the Health ministry approved the rates,” NHIF communications manager Anjela Mziray said on Monday.

“We cannot force everyone to accept the proposed packages, but it remains a fact that they were involved in the review,” she added.

NHIF director general Bernard Konga said last week that the review began in 2020 and involved key stakeholders, including APHFTA, religious organisations, the Medical Association of Tanzania, public hospitals and physicians in charge of district hospitals.

He said consultations were still going on to make sure that all stakeholders understand the review.

“We have come up with these reviewed rates after holding meetings with service providers and various other stakeholders. We did comprehensive research and satisfied ourselves that prices of some services were not in line with the market as they were either on the higher or lower side. So we have made some adjustments,” Mr Konga said.

However, APHFTA said much of the review involved the slashing of prices, with costs of 78 percent of medicines and services reviewed being cut by an average of 36 percent.

The association added that NHIF asked APHFTA members to install an online system and use it to submit payment claims for services offered so that they could be settled within 14 days,  but the situation had not changed despite the platform being up and running.

“Service providers’ payment claims can remain unsettled for up to six months and they (NHIF) sometimes reject some claims. They have chosen to lower rates despite these grievances having not been addressed. They want to destroy us,” APHFTA said.

“We have installed the system that has cost us millions of shillings, but we still have to wait for up to six months. If they think that operating costs have become too high, they should reduce unnecessary spending within the fund so that their members can be treated.

“We are asking Her Excellency President Samia Suluhu Hassan to intervene in this matter and help us because it seems they (NHIF) want to close down all private hospitals,” APHFTA said, adding that the private sector was playing a key role in the provision of health services.

The association also called for a review of NHIF subscription products and improvement of debt collection to strengthen the fund’s liquidity instead of looking for solutions that would only succeed in hurting service providers.

Taking into consideration claims lodged in September, October and November 2023, APHFTA estimates that all private hospitals from the dispensary to referral level would suffer a 25 percent loss on average.

Some of the reduced costs include those for dialysis for which NHIF will be paying Sh200,000 per session compared to Sh240,000 currently.

The cost of Erythropoietin 2,000 IU (the treatment of anaemia due to kidney problems) will has been lowered from Sh33,000 to Sh14,900, while that of Erythropoietin 4,000 IU has been decreased from Sh66,000 to 15,500.

Similarly, the consultation fee for specialists doctor at national referral and zonal referral hospitals has been reduced from Sh35,000 to Sh25,000, while that for general physicians (GPs) will drop from Sh10,000 to Sh5,000.

Last month, APHFTA conducted its 24th annual general meeting in which it also raised concerns over delayed payment and rejecting of claims, urging the NHIF to resolve the issue in three months.

The association also complained of regulatory challenges and a charge on ultrasound machines which it said adds cost on patients.