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Vituo vya afya vya kibinafsi sasa vinatishia kuacha kuwahudumia wanachama wa Mfuko wa Taifa wa Bima ya Afya (NHIF) wakipinga viwango vipya vya malipo ya huduma mbali mbali vinavyotarajiwa kuanza kutekelezwa Januari 2024. NHIF ilisema mapema mwezi huu kuwa imeboresha viwango hivyo vya malipo kwa kuongeza kiasi ambacho bima inayosimamiwa na serikali hulipia baadhi ya huduma na dawa na kupunguza nyingine.
NHIF Iliongeza kuwa viwango hivyo vilirekebishwa ili kuakisi hali iliyopo na kwamba wadau mbalimbali wa afya walishirikishwa katika uhakiki huo. Hata hivyo, Chama cha Vituo vya Afya Binafsi Tanzania (APHFTA) kilisema Jumatatu kuwa NHIF ilipitisha viwango hivyo vipya bila kuihusisha, na kuongeza kuwa hospitali nyingi zitafungwa kutokana na hasara "kubwa" ikiwa viwango hivyo vitaanza kutumika kama ilivyopangwa.
"Tunafikiri hatutaweza kuendelea kuwahudumia wanachama wa NHIF wakati viwango vipya vitakapoanza kutumika," APHFTA ilisema katika taarifa yake.
"Kwa kuzingatia ukweli kwamba viwango havijapitiwa upya katika miaka saba iliyopita, matarajio yetu yalikuwa kuona ongezeko la gharama za huduma za afya badala ya kupunguzwa."
APHFTA ilisema kuongezeka kwa kiwango cha malipo kutoka serikalini kungefidia ucheleweshaji wa malipo kwa hospitali binafsi, hasa ukizingatia mfumuko wa bei uliopo sasa na kushuka kwa thamani ya shilingi dhidi ya dola ya Marekani hivi karibuni.
Kwa mujibu wa NHIF, vifurushi hivyo vinavyoashiria huduma, bei za dawa na ada zinazolipwa na mfuko huo, vilipitiwa mwaka huu ili kuzingatia mabadiliko yaliyotokea tangu mwaka 2016 wakati uhakiki wa mwisho ulipofanyika.
NHIF Imeendelea kusisitiza kuwa uboreshaji wa viwango hivuo ulikuwa jumuishi na ulihusisha wadau mbalimbali muhimu, wakiwemo APHFTA.
“Tulishirikisha wadau mbalimbali na mazungumzo bado yanaendelea. Mchakato ulikuwa wazi kwa wadau wengi na wizara ya Afya iliidhinisha viwango hivyo,” meneja mawasiliano wa NHIF Anjela Mziray alisema. "Hatuwezi kulazimisha kila mtu kukubali vifurushi vilivyopendekezwa, lakini inabakia kuwa ukweli kwamba walihusika katika mapitio hayo," aliongeza.
Mkurugenzi Mkuu wa NHIF, Bernard Konga alisema wiki iliyopita kuwa uboreshaji huo ulianza mwaka 2020 na kushirikisha wadau wakuu wakiwemo APHFTA, mashirika ya dini, Jumuiya ya Madaktari Tanzania, hospitali za umma na madaktari wanaosimamia hospitali za wilaya. Alisema mashauriano bado yanaendelea ili kuhakikisha kuwa wadau wote wanaelewa uboreshaji huo.
"Tumepata viwango hivi vilivyoboreshwa baada ya kufanya mikutano na watoa huduma na wadau wengine mbalimbali. Tulifanya utafiti wa kina na kujiridhisha kuwa bei za baadhi ya huduma haziendani na soko kwani zilikuwa za juu au chini. Kwa hivyo tumefanya marekebisho,” Bw Konga alisema.
Hata hivyo, APHFTA ilisema uboreshaji mwingi ulihusisha upunguzaji wa bei, huku gharama za asilimia 78 za dawa na huduma zilizopitiwa zikipunguzwa kwa wastani wa asilimia 36. Chama hicho kiliongeza kuwa NHIF iliwataka wanachama wa APHFTA kufunga mfumo wa kielektroniki na kuutumia kuwasilisha madai ya malipo ya huduma zinazotolewa ili yaweze kumalizwa ndani ya siku 14, lakini hali haijabadilika licha ya mfumo huo kuanza kutumika. "Madai ya malipo ya watoa huduma yanaweza kubaki bila kutatuliwa kwa hadi miezi sita na wao (NHIF) wakati mwingine hukataa baadhi ya madai. Wamechagua kupunguza viwango licha ya malalamishi haya kutoshughulikiwa. Wanataka kutuangamiza,” APHFTA ilisema. “Tumefunga mfumo huo ambao umetugharimu mamilioni ya shilingi, lakini bado tunatakiwa kusubiri hadi miezi sita. Iwapo wanaona gharama za uendeshaji zimekuwa kubwa wapunguze matumizi yasiyo ya lazima ndani ya mfuko ili wanachama wao waweze kutibiwa. "Tunamuomba Mheshimiwa Rais Samia Suluhu Hassan aingilie kati suala hili na kutusaidia kwa sababu inaonekana (NHIF) wanataka kuua hospitali zote binafsi," APHFTA ilisema, na kuongeza kuwa sekta binafsi ina jukumu muhimu katika utoaji wa huduma za afya.
Chama hicho pia kilitoa wito wa kufanya mapitio ya gharama za usajili na vifurushi vya NHIF na uboreshaji wa ukusanyaji wa madeni ili kuimarisha mfuko huo badala ya kutafuta suluhu ambazo zitaumiza watoa huduma.
Kwa kuzingatia madai yaliyowasilishwa Septemba, Oktoba na Novemba 2023, APHFTA inakadiria kuwa hospitali zote za binafsi kutoka zahanati hadi ngazi ya rufaa zitapata hasara ya wastani wa asilimia 25. Baadhi ya gharama zilizopunguzwa ni pamoja na zile za kusafisha damu (dialysis) ambazo NHIF itakuwa inalipa Sh200,000 ikilinganishwa na Sh240,000 hivi sasa. Gharama ya Erythropoietin 2,000 IU (matibabu ya upungufu wa damu kutokana na matatizo ya figo) imepunguzwa kutoka Sh33,000 hadi Sh14,900, wakati ile ya Erythropoietin 4,000 IU imepunguzwa kutoka Sh66,000 hadi 15,500.
Vilevile, ada ya kumuona daktari kwa madaktari bingwa katika hospitali za rufaa za kitaifa na za rufaa za kanda imepunguzwa kutoka Sh35,000 hadi Sh25,000, huku ile ya madaktari wa kawaida (GPs) ikishuka kutoka Sh10,000 hadi Sh5,000.
Mwezi uliopita, APHFTA ilifanya mkutano wake mkuu wa 24 wa mwaka ambao pia iliibua wasiwasi kuhusu kucheleweshwa kwa malipo na kukataliwa kwa madai, na kuitaka NHIF kutatua suala hilo katika muda wa miezi mitatu. Chama hicho pia kililalamikia changamoto za udhibiti na tozo kwenye mashine za Ultrasound jambo ambalo lilisema linaongeza gharama kwa wagonjwa.
Source: Citizen
Private health facilities are now threatening to stopa 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.
Pia soma: NHIF hawajatulipa Watoa Huduma kwa miezi mitano, wanatupa ugumu kuhudumia wenye uhitaji
NHIF yakanusha kadi za wanachama kutotumika katika hospitali binafsi
NHIF Iliongeza kuwa viwango hivyo vilirekebishwa ili kuakisi hali iliyopo na kwamba wadau mbalimbali wa afya walishirikishwa katika uhakiki huo. Hata hivyo, Chama cha Vituo vya Afya Binafsi Tanzania (APHFTA) kilisema Jumatatu kuwa NHIF ilipitisha viwango hivyo vipya bila kuihusisha, na kuongeza kuwa hospitali nyingi zitafungwa kutokana na hasara "kubwa" ikiwa viwango hivyo vitaanza kutumika kama ilivyopangwa.
"Tunafikiri hatutaweza kuendelea kuwahudumia wanachama wa NHIF wakati viwango vipya vitakapoanza kutumika," APHFTA ilisema katika taarifa yake.
"Kwa kuzingatia ukweli kwamba viwango havijapitiwa upya katika miaka saba iliyopita, matarajio yetu yalikuwa kuona ongezeko la gharama za huduma za afya badala ya kupunguzwa."
APHFTA ilisema kuongezeka kwa kiwango cha malipo kutoka serikalini kungefidia ucheleweshaji wa malipo kwa hospitali binafsi, hasa ukizingatia mfumuko wa bei uliopo sasa na kushuka kwa thamani ya shilingi dhidi ya dola ya Marekani hivi karibuni.
Kwa mujibu wa NHIF, vifurushi hivyo vinavyoashiria huduma, bei za dawa na ada zinazolipwa na mfuko huo, vilipitiwa mwaka huu ili kuzingatia mabadiliko yaliyotokea tangu mwaka 2016 wakati uhakiki wa mwisho ulipofanyika.
NHIF Imeendelea kusisitiza kuwa uboreshaji wa viwango hivuo ulikuwa jumuishi na ulihusisha wadau mbalimbali muhimu, wakiwemo APHFTA.
“Tulishirikisha wadau mbalimbali na mazungumzo bado yanaendelea. Mchakato ulikuwa wazi kwa wadau wengi na wizara ya Afya iliidhinisha viwango hivyo,” meneja mawasiliano wa NHIF Anjela Mziray alisema. "Hatuwezi kulazimisha kila mtu kukubali vifurushi vilivyopendekezwa, lakini inabakia kuwa ukweli kwamba walihusika katika mapitio hayo," aliongeza.
Mkurugenzi Mkuu wa NHIF, Bernard Konga alisema wiki iliyopita kuwa uboreshaji huo ulianza mwaka 2020 na kushirikisha wadau wakuu wakiwemo APHFTA, mashirika ya dini, Jumuiya ya Madaktari Tanzania, hospitali za umma na madaktari wanaosimamia hospitali za wilaya. Alisema mashauriano bado yanaendelea ili kuhakikisha kuwa wadau wote wanaelewa uboreshaji huo.
"Tumepata viwango hivi vilivyoboreshwa baada ya kufanya mikutano na watoa huduma na wadau wengine mbalimbali. Tulifanya utafiti wa kina na kujiridhisha kuwa bei za baadhi ya huduma haziendani na soko kwani zilikuwa za juu au chini. Kwa hivyo tumefanya marekebisho,” Bw Konga alisema.
Hata hivyo, APHFTA ilisema uboreshaji mwingi ulihusisha upunguzaji wa bei, huku gharama za asilimia 78 za dawa na huduma zilizopitiwa zikipunguzwa kwa wastani wa asilimia 36. Chama hicho kiliongeza kuwa NHIF iliwataka wanachama wa APHFTA kufunga mfumo wa kielektroniki na kuutumia kuwasilisha madai ya malipo ya huduma zinazotolewa ili yaweze kumalizwa ndani ya siku 14, lakini hali haijabadilika licha ya mfumo huo kuanza kutumika. "Madai ya malipo ya watoa huduma yanaweza kubaki bila kutatuliwa kwa hadi miezi sita na wao (NHIF) wakati mwingine hukataa baadhi ya madai. Wamechagua kupunguza viwango licha ya malalamishi haya kutoshughulikiwa. Wanataka kutuangamiza,” APHFTA ilisema. “Tumefunga mfumo huo ambao umetugharimu mamilioni ya shilingi, lakini bado tunatakiwa kusubiri hadi miezi sita. Iwapo wanaona gharama za uendeshaji zimekuwa kubwa wapunguze matumizi yasiyo ya lazima ndani ya mfuko ili wanachama wao waweze kutibiwa. "Tunamuomba Mheshimiwa Rais Samia Suluhu Hassan aingilie kati suala hili na kutusaidia kwa sababu inaonekana (NHIF) wanataka kuua hospitali zote binafsi," APHFTA ilisema, na kuongeza kuwa sekta binafsi ina jukumu muhimu katika utoaji wa huduma za afya.
Chama hicho pia kilitoa wito wa kufanya mapitio ya gharama za usajili na vifurushi vya NHIF na uboreshaji wa ukusanyaji wa madeni ili kuimarisha mfuko huo badala ya kutafuta suluhu ambazo zitaumiza watoa huduma.
Kwa kuzingatia madai yaliyowasilishwa Septemba, Oktoba na Novemba 2023, APHFTA inakadiria kuwa hospitali zote za binafsi kutoka zahanati hadi ngazi ya rufaa zitapata hasara ya wastani wa asilimia 25. Baadhi ya gharama zilizopunguzwa ni pamoja na zile za kusafisha damu (dialysis) ambazo NHIF itakuwa inalipa Sh200,000 ikilinganishwa na Sh240,000 hivi sasa. Gharama ya Erythropoietin 2,000 IU (matibabu ya upungufu wa damu kutokana na matatizo ya figo) imepunguzwa kutoka Sh33,000 hadi Sh14,900, wakati ile ya Erythropoietin 4,000 IU imepunguzwa kutoka Sh66,000 hadi 15,500.
Vilevile, ada ya kumuona daktari kwa madaktari bingwa katika hospitali za rufaa za kitaifa na za rufaa za kanda imepunguzwa kutoka Sh35,000 hadi Sh25,000, huku ile ya madaktari wa kawaida (GPs) ikishuka kutoka Sh10,000 hadi Sh5,000.
Mwezi uliopita, APHFTA ilifanya mkutano wake mkuu wa 24 wa mwaka ambao pia iliibua wasiwasi kuhusu kucheleweshwa kwa malipo na kukataliwa kwa madai, na kuitaka NHIF kutatua suala hilo katika muda wa miezi mitatu. Chama hicho pia kililalamikia changamoto za udhibiti na tozo kwenye mashine za Ultrasound jambo ambalo lilisema linaongeza gharama kwa wagonjwa.
Source: Citizen
Private health facilities are now threatening to stopa 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.
Pia soma: NHIF hawajatulipa Watoa Huduma kwa miezi mitano, wanatupa ugumu kuhudumia wenye uhitaji
NHIF yakanusha kadi za wanachama kutotumika katika hospitali binafsi
