Doctors are making individual medical insurance expensive

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Doctor holding out his stethoscope

Assuming you are a Kenyan of adult age, and at one time, or another, or even another, you have received a card printed on coloured manila. The card will have a table on the back side, usually two large columns, and two or three smaller columns. The front should have some writings, followed by typed columns of a number of names.

See, I would know because my first job involved printing fundraising cards, including those for fundraising for medical bills.

Often, as people found out, you would end up admitted in hospital after some illness, or after being involved in those road accidents that injure between 10,000 and 15,000 every year. Another 3,000 never survive their injuries every year. Another reason that sees you ending up in a hospital may be disease – some bacterial infection, cancer and many more, especially in Africa.

Simply put, getting ill, or running into an accident in Africa, can seriously put you at risk of bankruptcy and take you a while to emerge from it. Traditionally, Africans tackle this issue by social insurance – Harambee, where the community pools together to bail you out.

Well, Africans are not particularly known for planning. If you do not believe me, watch how unplanned people are when it gets to lunch time – the hunger hits them by surprise, as if lunch has never occurred to them. However, taking it that you are one of the new-thinking Africans, who tries a lot to be self-reliant and plan ahead for the avoidable and the inevitable, planning for that hospital bill is a headache.

Well, there are lots of insurance firms in the country. The problem though, is if you want individual insurance – insurance that is offered to you alone, and not your company, or family. Medical insurance is cheaper if you have a wife and children (no idea what happens if you have a husband) or if you are doing it for your firm.

As an example, inpatient (admissions) and outpatient (walk in and walk out) will set you back somewhere starting at Ksh. 35,000 annually, or Ksh. 40,000 if you are looking for good limits and a broad selection of institutions. Yes, insurance has limits – depending on how much you pay, you get limits for how much you can spend on outpatient and on inpatient in a year.

The Ksh. 40,000 has to be paid before you start enjoying the cover. You can get financing from your bank that will allow you to pay 3 installments, but at an extra Ksh. 4,000 or more.

But why is individual medical insurance so damn expensive?

My actuarial friend tells me doctors are to blame for their fraud.

On hearing that you are paying them by insurance, doctors are notorious for suggesting all sorts of unnecessary tests, such as x-rays for headaches and pregnancy tests for men and prescribing all sorts of medicines. Well, okay, the pregnancy test is a fabrication, but you get it. These unnecessary tests end up costing money that is paid by your insurance provider.

The doctors hang their stethoscope and shrug, biashara ni biashara.

It doesn’t help that more and more doctors are misdiagnosing their patients. I’m told that there is an option for doctors nowadays to speed through their medical course in three years – sickening, seeing that diagnosis is more about experience than what you read.

See, a few people will end up spending much more than Ksh. 40,000 on their medical costs. Medical insurance is designed with the assumption that many of you will not visit the hospital – hence why it gets costlier as you age and become more likely to visit a hospital.

Family guys, I’m told, tend to be conservative on their hospital visits as they share their limits with the rest of the family. As for companies, most employees even forget they do have medical insurance.

The abuse of medical insurance by doctors and individuals thus makes individual medical insurance expensive.

You will therefore find it hypocritical that your doctor took a Hippocratic oath – to practice medicine honestly – but ends up seeing medical insurance as a cash cow, causing this to be priced out of reach in a country where medical care is inaccessible to many.

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