As published on Standardmedia.co.ke on November 20th 2021
Teachers have visited hospitals 12 million times to seek medical care in the last six years under the Minet Kenya insurance scheme, laying bare the tutors’ disease burden, a status report shows.
These visits include inpatient, outpatient, dental and optical treatment, and maternity and delivery cases.
According to the report, those who sought medical care had cases of high blood pressure, diabetes and asthma, which also rank among the most common chronic diseases among the tutors.
Statistics from the teacher’s medical scheme shows that at least 10,757 teachers and their dependents are presently in hypertension management programme.
Another 3,771 teachers are on diabetes care while some 1,033 are on asthma management.
The report shows that convulsive disorder closes the top four chronic diseases teachers and their dependents suffer from, affecting some 510 beneficiaries.
Other chronic ailments under the scheme are thyroid diseases with some 229 under care and Benign Prostatic Hyperplasia (BPH) — also called prostate gland enlargement – with 177 members enrolled for care.
Mental disorders account for 170 cases, followed by sickle cell (146), renal disorders (83) and gout arthritis with 68 cases.
The medical scheme is administered by Minet Kenya. Teachers Service Commission (TSC) contracted the insurer on July 1, 2015 to manage the multi-billion-shilling medical plan.
Overall, the Teachers Medical Scheme Status Report shows that Outpatient care accounts for 88 per cent of the visits while inpatient takes three per cent.
The remaining visits – nine per cent – are split between optical, dental and maternity.
“All these visits are made within our countrywide panel that has about 657 individual medical provider outlets,” reads report.
And some 360 cases have been treated overseas under the scheme, with an average of 60 patients taken abroad for treatment.
The report says some 6,549 beneficiaries of the scheme have lost their lives since the scheme’s inception. It also shows that under group life and last expense, the number of teachers dying has reduced, translating to reduced claims.
The benefit is paid two-fold with Sh200,000 being paid towards the funeral expenses and, thereafter, a lumpsum group life benefit is paid to assist the family meet some immediate financial needs.
Each year these benefits are paid to approximately 1,000 lives.
“Before scheme was rolled out the number of teachers losing lives was high. But this has substantially reduced since 2015,” reads report prepared by Sammy Muthui, Minet Kenya chief executive.
Report says: “Teachers’ medical scheme has changed lives of teachers and improved their quality of life by reducing the disease burden on family resources including reduction of the out-of-pocket expenditure.”
In October last year, Minet got a new three-year deal to manage the cover under enhanced benefits for all teachers employed by the government.
By July this year, report says the scheme had 334,531 registered teachers who are the principal members and some 188,912 spouses. Cover only allows one spouse.
Total registered dependents of the scheme presently stand at 734,372, according to report titled Teacher Preparedness for Term 1, (2021-2022) Opening.
It covers children who are aged 0-18, who are still under parental care. Also covered are children aged 19-25 who are assumed to be in school. Documentary evidence is required for this category.
As the scheme moves into its seventh year, report says that so far outpatient services has recorded the highest visits with some 10,476,363 cases recorded.
This means that some 139,565 teachers visit hospitals every month under this category, translating to 4,780 visits daily.
According to the report, the number of teachers and their dependants going for eye check-ups rank second, with some 524, 527 visits. Report says some 6,994 teachers visit hospitals every month seeking eye check-ups.
“Due to the comprehensive nature of the scheme about 80,000 spectacles are issued per annum going by the number of optical consultations made. The scheme has enabled many teachers and their dependants improve their quality of life by improved eyesight derived from this benefit,” reads the report.
This is followed by dental checkups, which stands at total 382,997 visits recorded so far. This means that every month, 5, 107 teachers seek dental services in hospitals.
Of the total visits, 341, 509 cases have been booked for admissions. Which translates to 4, 553 teachers put on ward beds every month.
“On a daily basis, there are about 150-200 inpatient cases seen under the scheme from an average of 4,700 outpatient visits per day,” says the report.
Maternity forms the lowest number of hospital visits with only 116,510 cases reported. This means that 1,553 pregnant female teachers visit medical facilities every month.
“Under the maternity benefit almost 20,000 maternity cases are seen per annum which translates to additional child dependents under the scheme,” reads report.
Under the enhanced cover, inpatient was increased to between Sh750,000 and Sh2.5 million. Previously, this cover ranged from Sh500,000 to Sh1.5 million across the various job groups.
Outpatient cover, which was unlimited until last year, is now capped at between Sh100,000 and Sh375,000 across job groups. Other improved benefits are under optical cover, for which teachers and their dependents are entitled to a total of Sh45,000.
Previously, it ranged between Sh10,000 and Sh25,000. Dental cover is presently capped at a flat rate of Sh35,000 up from between Sh10,000 and Sh25,000.
Maternity cover, previously capped at Sh75,000, has been enhanced to between Sh100,000 and Sh200,000.
The report says that some 360 cases have been treated overseas under the scheme.
Over and above hospital visits, the scheme offers overseas treatment and transport costs for the accompanying person.
According to the report, this benefit allows members who require treatment out of the country to access expert treatment that is not locally available.
In addition to this, the scheme also offers local air and road rescue and evacuation service, which caters for movement of patients from one hospital to the next where higher level of treatment is required. At times, the cover also evacuates members from accident scenes to hospital.