More than half of NHIF members defaulted on contributions

More than half of the members previously enrolled in the now-defunct National Health Insurance Fund (NHIF) failed to pay their monthly contributions, adding pressure to the public medical insurance system and raising concerns about its financial stability.

An NHIF Board Exit Report from November 2024 reveals that out of 16.2 million registered members, only 7.1 million were actively contributing.

This means that about 56 percent, or more than 9.1 million members, had defaulted on payments.

The number of inactive members increased by 300,000 from the previous year’s figure of 8.8 million.

At the same time, NHIF processed 8.5 million claims, reflecting the continued demand for healthcare services among members despite a decline in contributions. These claims covered hospital admissions, outpatient visits, maternity care, and specialised treatment.

“During the period under review, 8,464,880 claims were processed for a total of Sh57.8 billion, while capitation payments amounted to Sh7.3 billion. As of 30 June 2023, the total active membership stood at 7.1 million members from formal, informal, and sponsored programmes, representing 44 percent of the total enrolled membership of 16.2 million,” stated the report.

NHIF paid Sh70.9 billion in total benefits against total contributions and premiums of Sh81.6 billion, resulting in a loss ratio of 87 percent.

This means that for every Sh100 collected in premiums, Sh87 was used for claims and expenses.

The claims ratio had risen from 83 percent in the previous year, signaling increased reliance on NHIF for medical care. Contributing factors included the rising cost of healthcare services, frequent hospital visits, and an expansion in benefits.

As of December 2023, the government owed NHIF Sh30 billion in unpaid premiums, while healthcare providers awaited Sh25.4 billion in reimbursements.

“Total benefits paid as of June 30, 2023, amounted to Sh70.1 billion against contributions and premiums of Sh81.6 billion, resulting in a loss ratio of 87 percent,” the report added.

Despite financial strains, NHIF recorded revenue growth in the 2022-2023 financial year, increasing from Sh78.16 billion in the previous period to Sh81.60 billion.

Membership also grew from 15.46 million to 16.21 million, while settled claims rose from Sh58.67 billion, reflecting a growing need for medical coverage.

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