Medical Administrators Kenya Ltd Management Inept, Unable To Pay For Teachers, Police Insurance

On November 21, 2023, Ms Rosemary Kuraru on behalf of Inspector-General of Police Japheth Koome, wrote to the CEO of CIC General Insurance Limited over the Nairobi West Hospital’s demand for payment of outstanding claims.

The teachers’ medical service scheme, which has now become a source of numerous complaints over poor services, has run for nine years. What has concerned the National Assembly and the Senate is that MAKL is a private company and that the procurement of insurance for TSC is disguised as an insurance scheme.

The scheme tendering entity for TSC is Minet Kenya and for police is a consortium of insurance companies led by CIC General Insurance Limited.

The two insurance companies then contracted MAKL which charges up to 7 percent in administration fees to the tender amount as capitation administrator.

The premiums as provided by the government are paid directly by the procuring entities- TSC, NPSC- to Minet Kenya and CIC General Insurance Limited.

The funds are then channelled by the insurance companies to MAKL for capitation purposes, which then empanels hospitals and doctors that are then tied up as a network of hospitals to provide services for the scheme.

The suffering of the insured under the schemes starts when MAKL, which retains all the rights for admission, negotiates with hospitals to provide the services usually at very low capitation fees for patients as it aims to maximise profits.

The hospitals also need to make profits from the low capitation fees from MAKL.

In the end the hospitals contracted by MAKL maximise profits by way of either outright denial of services or endless frustrations like being kept waiting for hours so that patients give up and opt to pay for treatment from their pockets in other health facilities.

The Education Committee of the National Assembly was recently told that surgery, which requires immediate medical intervention, takes days “until one gives up for out-of-pocket financing elsewhere or dies while still waiting to be treated.”

The fewer the patients a hospital under MAKL treats, the more money it makes from the capitation fees.

In getting to the bottom of these issues, the Senate has lined up TSC, NPSC and Insurance Regulatory Authority (IRA) among others for explanations on actions taken to address the delays by MAKL in processing the claims.