Category Archives: medical insurance

Reading the Nairobi Hospital tea leaves

What does a read of The Nairobi Hospital, which is probably the top hospital in East Africa, tell us about the state of medical investments here? The Nairobi Hospital (NH) was founded in 1954, and it, alongside Aga Khan Hospital,  is where top leaders, politicians from Kenya and the East Africa region are treated. It is also where middle-class Kenyans, tourists, and anyone with private medical insurance is treated or operated on.

Nairobi Hospital room

But treatment at Nairobi Hospital is not cheap; , a few days stay without surgery will cost about Kshs 300,000 (about $3,000) and a night in the intensive care unit (ICU ) is about Kshs 500,000!
Kenyans who have medical conditions have discovered that traveling to India for surgery, medicine, and other complex treatment procedures is a better option, even after one factors in the cost of travel for patient and relatives who oversee the patient.
Anyway, how does the Nairobi Hospital (officially registered as the Kenya Hospital Association) in 2016 compare to a few years earlier with the hospital’s 2009 report?
  • Turnover was Kshs 8.79 billion (~$88 million), up from 8.0 billion in 2015.
  • They had a surplus of Kshs 1.3 billion  ($13 million) up from Kshs 1.06 billion, but below the Kshs 1.4 billion in 2014.
  • Some income items: Pharmacy income was 2.5 billion (a 13% growth on the previous year) and the pharmacy had 60% growth in chemotherapy sales thanks to NHIF package (partnership with NHIF has opened doors to our brothers and sisters who would otherwise have not received world class health services. This has seen a rise in number of patients accessing their preferred health care in our Cancer Center, Renal Unit and Catheterization Laboratory. Laboratory income was Kshs 1.4 billion (they have also implemented o shore reporting from India for CT scan, MRI and mammography). Physiotherapy revenue was Kshs 246 million, and accident and emergency revenue was Kshs 374 million (53% of visits were done in 75 minutes and they plan to reduce the waiting time).
  • Some expense items: The Nairobi Hospital paid salaries of Kshs 2.5 billion (compared to Kshs 2.1 billion in 2015) and they added 276 staff in the year (including 128 nurses), a CEO, Company Secretary, and a Security Manager. Key management compensation dropped from Kshs 130 million to Kshs 93 million (in 2015) – and does that difference correspond to the salary of the outgoing CEO who left to become Kenya’s Cabinet Secretary for Health? They also bought medicine worth Kshs 1.7 billion, paid cleaning costs of Kshs 71M, Oxygen with 41M and paid Kshs 21 million to credit card companies
  • The Nairobi Hospital invested Kshs 2.1 billion in projects such as pharmacy, water storage, parking, nurses accommodation, roads, fencing, and kitchen improvements. They also hired a marketing agency to improve the image and awareness about services at the hospital and participated in news interviews, features, and social media.  
  • Some operational numbers for the hospital: They had 154,760 visits to accident & emergency centre, carried out 685,802 lab tests, handed out 354,296 prescriptions, and did 98,198 radiology procedures. They had 18,386 admissions, had 2,730 births (a 17% decline from the year before), and did 7,990 major operations and 1,975 minor ones. They also an occupancy level of 79%, which was down from 81% on their 299  beds, and they retained their customer satisfaction measure of 89%.  The relocation of their ICU / HDU units temporarily reduced capacity from 356 to 299 beds. 
  • On the finance side, they had cash and equivalents of Kshs 2.7 billion (down from 3.5 billion) but still a very healthy liquidity position. They also had Kshs 399 million at Imperial Bank and had Kshs 280 million of doubtful debts (up from 240 million), and Kshs 24 million in foreign exchange losses from currency fluctuations.  
  • The new Nairobi Hospital CEO wrote that his strategy would revolve around talent, technology, turnaround and territory (new location to enhance service). On the health industry, which contributes 6% to GDP, he wrote that income at the Kenya government’s National Hospital Insurance Fund (NHIF) had more than doubled to Kshs 28.5 billion in 2016 thanks to new rates levied on Kenyan workers and that there were 172,706 health personnel in Kenya in 2016.
 
Website of the Nairobi Hospital.  

Makueni County Healthcare

The Makueni County government is this week conducting new registration for a universal healthcare program in the 60 sub-wards in the county.  The Makueni University Healthcare program will provide essential health services to county residents at eight sub-county hospitals, and the county referral hospital.

It is being lauded and Makueni Governor Kivutha Kibwana who previously battled with the county assembly (parliament) that he was elected alongside in 2013, now appears to be enjoying a resurgence after his re-election on August 8 which he easily won, while 29 of the 30 county assembly legislators (MCA’s) were voted out.

The MCA’s had tried to impeach the Governor and he subsequently moved to dissolve the entire county government. A commission on inquiry looked into the disputes at Makueni and made some recommendations to the President, but as he never forwarded the report to the Senate for debate and approval, the situation was never fully resolved, until the 2017 election.

In promoting the Makueni health care program, the county government states the high level of poverty (60%) in the region as a reason why they set out to provide free health care to senior citizens (above 65 years of age) in the county through a pilot program in 2016. They deemed it a success and decided to expand it to universal health care and they have already enrolled another 33,344 households, excluding the senior citizens. The ongoing registration aims to net 180,000 new households and the benefits of the program will be improved health care with no out-of-pocket expenses for households which have previously resorted to selling livestock or land to meet family medical expenses. During the test phases, Kshs 138 million was expensed, with the bulk of that going to pharmacy expenses (33%), then inpatient (24%) and laboratory (15%) expenses.

The Makueni program will pay for emergency healthcare, laboratory, radiology, theater, cancer screening, drugs, and ambulance evacuation, among other expenses. The cost is Kshs 500 per year for a household and that will cover a nuclear family – beneficiary, spouse(s) and dependents of school going age. It is separate from the government’s national hospital insurance fund (NHIF), and Makueni will not cover services outside the county, such as scans, MRI’s, post-mortems, ICU, dialysis, and other specialized services not available within the county.

The ambitious and novel Makueni program is similar to one in Muranga county that sought to mobilize savings for county investments, but which was scuttled by regulators and wary investors.

The latest Auditor General (OAG) reports on Makueni noted that the county government received (2015) revenue of Kshs 6.3 billion (that included Kshs 5.9 billion from the national government) and that Kshs 5.4 billion was spent, leaving a Kshs 0.9 billion surplus. The OAG noted the disruption of the government activities but gave an adverse opinion on the Makueni county assembly (legislators) accounts while those of the county government (executive) were qualified. The executive was flagged for operating bank accounts at banks other than the Central Bank, and also for issues with the procurement of assets and construction of dams. The report on the assembly noted issues with lack of supporting documentation, hiring of professionals, including lawyers in the case against the governor, and trips that Makueni MCA’s had made to Mauritius, Boston, London, Malaysia Dubai and Singapore.

Make Innovation the Centre of your Business and Job or Face Disruption

These were the words of Brett King, a futurist and bestselling Author spoke about disruptive innovation to guests at a business forum at the Capital Club, Nairobi. He had been invited by KCB Group, Kenya’s largest bank, which he is advising on a digital finance strategy.

He said that companies that are based on innovation and technology ( E.g Google, Facebook, Alibaba, Baidu, have ten times more profit (~$500,000 per employee) than traditional companies of ($30,000 per employee) or banks ($50,000 per employee)  as they are more efficient at converting production to profits

Other comments:

  • Historically technology that is cool but disruptive ,is resisted and he compared Luddites who smashed factory machinery in England in 1812, to taxi drivers smashing Uber cars in France 200 years later.
  • He expected more contextualization of financial service a based on location and behaviour: e.g. walk into an Apple Shop and you get a finance offer on your phone about a new device you have been longing to buy.
  • Bitcoin’s ability to be a currency is hampered because owners of the coins are hoarding them like gold so they appreciate in price (which is now $1,000). They are not using the bitcoins to make payments which are what currencies are meant to do.
  • There’s a bright future for peer to peer (P-2-P) insurance (more than P-2-P lending).
  • The service jobs there today will be replaced by automation/robotics. But this creates even newer service jobs (every job lost to technology create 2.6 others), and students considering careers should ask themselves how they will compete with Artifical Intelligence (AI) or work in jobs that enable the future e.g. solar adapters.
  • Entrepreneurs should create businesses that take advantage of AI. The mid-2030’s will be an exciting time as there will be more energy from renewable sources than fossil fuels and more robots than humans.
  • On Kenya’s revolutionary M-pesa, which had facilitated the fastest financial inclusion shift in history, he said it was clunky as it was designed for feature phones.

Lipa Kama Tender

hospital-bed

Lipa Kama Tender

This evening, Kenyan public sector nurses called off their strike after the government agreed to implement a collective bargaining agreement (CBA) deal. It’s been a painful week for patients around the country as nurses and doctors have been on strike at many public hospitals and medical facilities. Anyone who has spent time in a hospital realizes how much work the nurses do in terms of taking care of patients, alongside doctors – who themselves are still on strike, also awaiting the government to implement their CBA signed n 2013?.

The striking workers used the solidarity slogan “lipa kama tender” – Swahili for “pay (us) the way you pay (government) tenders” as a play on the widespread reports of the government paying out millions and billions of shillings of taxpayers and donor money in overpriced, corrupt, fraudulent tenders for supply of goods or services – some of which were for health-related equipment procurement, and which were flagged by an auditor who has since been removed from the sector.

Insurance vs Betting

Last week I got an email from an insurance company titled insurance vs. gambling. I deleted it immediately, but later thought about what it meant. Why is it that it is hard for vital sectors like insurance and pensions to get traction in this country? Their levels remain low, yet people flock to what are likely losers like sports betting, gambling and pyramid scheme.

Every time my cousins visit from the village,  I marvel at how many of them are into sports betting. They know teams in many obscure  soccer  leagues in many countries and make bets to fill out their winning brackets. They all remember their big wins, “Kshs 8,000” or “Kshs 22,000” that was sent directly to their mobile phone as they slept, but they can’t or won’t tell you about how much spend every week to get those winnings.

Pic by MediaclubSA of street in Molimode (from AfricaKnows.com)

Pic by MediaclubSA of street in Molimode (from AfricaKnows.com)

As I started to write this I was at a doctor’s office. I ate some food and ended up with  a bad stomach. A mentor had warned me that bad food and the flu were “putting down” a lot of people in Nairobi now, and so I went to get some help.

Earlier, I had been at Coop Bank to speak to them about their various medical insurance products. They have high-end packages and low-end ones that costs Kshs 15,000 to cover a family for one year, and with just Kshs 9,000 to start, a family is covered with both in-patient & out-patient care.

For small companies they waive all waiting requirements and pre-conditions and for individual joining from another medical cover plan, the same requirements are also waived. There is no co-pay (no money paid for treatment) and they are accessible at centres all over the country. It covers people goes up to 74 years and includes operations and treatment in India and South Africa, if a doctor recommends treatment that’s not available locally.

A typical doctors visit in Nairobi ranges from Kshs 3,000 to 10,000 for doctors visits, medication and lab work (if required). Every young person should have insurance, for themselves and their families such as the plans at Co-op branches and agents.

But back to the inspiration for the post. I also got an email from a popular sports betting company. It came just a few days before the final of the Euro 2016 soccer tournament, and listed some of the odds that could have won me some money. Besides the outcome of the game, which few could have predicted, here are other bets that one could have placed:

  • Portugal vs. France: 1 (4.13) X (3.10) 2 (2.02 [whatever that means!]
  • Cristiano Ronaldo not to score. 1.24 
  • Cristiano Ronaldo to score first and Antoinne Greizmann not to score. 8.82
  • Both Cristiano Ronaldo and Antoine Greizmann to score anytime. 8.70
  • Renato Sanches to score anytime. 8.50
  • Paul Pogba to score anytime. 4.50
  • Over 2.5 goals: 2.60
  • Both teams to score: 2.20