Julius Melly, the Chairman of the National Assembly Departmental Committee on Education. Photo | courtesy.
The Teachers’ Medical Scheme, which provides healthcare services to educators in Kenya, is facing scrutiny from the National Assembly Departmental Committee on Education due to concerns over healthcare access and administrative delays.
The scheme, which is operated by Minet, includes a hybrid model that seeks to balance cost optimization with maintaining care standards.
The consortium behind the scheme comprises nine entities, including Bliss GVS Healthcare Limited and Medical Administrators Kenya Limited (MAKL), which play a role in its implementation.
One of the key issues raised by the committee is the approval process for critical medical treatments. In response, Minet outlined a process where each case is reviewed individually by medical professionals to ensure timely and accurate decisions.
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Concerns have also been raised regarding the adequacy of coverage, particularly for high-cost procedures and chronic disease management. The scheme ensures that all medically necessary treatments are covered within applicable limits.
To improve healthcare access in rural areas where medical facilities are limited, the scheme has expanded its network of accredited providers, including partnerships with county government health institutions.
However, the scheme has faced financial challenges, resulting in delays in payments to healthcare providers. While 95 percent of contracted providers continue to offer services, alternative providers have been identified in affected areas.
In response to concerns over fraudulent claims, Minet has implemented anti-fraud systems, including real-time monitoring and dedicated investigation teams. The consortium has also streamlined administrative processes to improve efficiency, including simplified referral protocols for overseas treatment.
Additionally, the procurement and accreditation of medical service providers are being managed to ensure fairness and value for money.
