Introduction
The introduction of the Social Healthcare Insurance Fund (SHIF), is aimed at providing affordable and accessible healthcare services to its citizens. The fund, which is part of the government's broader healthcare reforms, seeks to address the challenges of high medical costs and limited access to healthcare services, especially for vulnerable populations. The SHIF is set to replace the National Healthcare Insurance Fund (NHIF).
Key Features of the Fund:
Universal Coverage:
The fund aims to provide health insurance coverage to all Kenyan citizens, regardless of income or employment status. This includes individuals working in the formal and informal sectors and the unemployed and elderly.
Affordable Contributions:
The fund is designed to be affordable for all citizens. Contributions will be based on a sliding scale, with lower-income individuals paying less than higher-income individuals.
Comprehensive Benefits:
The fund will cover a wide range of healthcare services, including outpatient and inpatient care, maternity services, and emergency medical care. It will also include preventive and promotive healthcare services, such as regular check-ups and vaccinations.
Family Coverage for contributor’s family members, such as spouses, children, and disabled dependents.
Educational support; Students up to 25 years old in full-time education are covered, recognizing the importance of healthcare for young adults in education.
Implementation:
The fund will be implemented through a network of accredited healthcare providers, both public and private. Citizens can choose their preferred healthcare provider and access services using their insurance cards.
Categories:
- Primary Health Care Fund
- Every person resident in Kenya shall access healthcare service
- One must be registered under SHIF to get the services
- Access to level 2 or 3 Healthcare facilities
- Services;
- Promotive Services
- Preventive Services
- Curative Services
- Rehabilitative Services
- Palliative Care Services
- Social Health Insurance Fund (SHIF)
- Accessed on Referral from primary health facilities (level 2 or 3)
- Services provided by level 4, 5, and, 6 health facilities
- Mandatory registration is required
- Each beneficiary will acquire a social health number
- Contributors may list beneficiaries in the application form
- Persons registered under the NHIF shall be required to register afresh
- Newborns to be registered within 14 days
- The child’s biometrics shall be collected at the age of 7 years
- Statutory deduction at the rate of 2.75% of the gross salary or household income
- Minimum contribution of Ksh. 300 per month
- A person shall be treated as a household upon attaining 25years
- A beneficiary shall be de-registered upon death
- Emergency Chronic and Critical Illness Fund (ECCIF)
- Provision of emergency services and critical care
- Treatment of chronic and critical illnesses
- Offered to all beneficiaries of the Social Health Insurance Fund
- Beneficiary suffering from a chronic illness shall transition to this fund upon depletion of SHIF
Contributions:
Salaried Individuals contribute 2.75% of their gross salary
Non-salaried & unemployed contribute 2.75% of the household income with the minimum amount being Ksh 300 per month
Gross Pay (Ksh) | Old Deductions - NHIF (Ksh) | New Deductions - SHIF (Ksh) |
20,000 | 750 | 550 |
50,000 | 1,200 | 1,375 |
100,000 | 1,700 | 2,750 |
150,000 | 1,700 | 4,125 |
200,000 | 1,700 | 5,500 |
500,000 | 1,700 | 13,750 |
1,000,000 | 1,700 | 27,500 |
Challenges:
Sustainability:
Ensuring the long-term sustainability of the fund will be critical. The government needs to develop a robust financing mechanism that can support the fund's operations and ensure its continued viability.
Fraud and Abuse:
The fund must have effective measures to prevent fraud and abuse, as these can undermine its financial stability and erode public trust.