Starting January 1, Kenyans visiting private hospitals with the new government health insurance might be forced to pay out of pocket according to the hospital’s umbrella body.
The Rural and Urban Private Hospitals Association of Kenya (RUPHA) has warned that patients seeking medical attention at the hospitals with Social Health Authority (SHA) cards will be required to pay cash to access services.
According to the hospitals, the government has failed to commit to paying the Ksh29 billion owed to the hospitals by the now-defunct National Health Insurance Fund (NHIF).
“Unless there is a substantial move to settle NHIF liabilities. From the 1st of January, we will move to out-of-pocket payment. We have no other way. How do we keep the facilities open? You cannot have three-quarters of hospitals that have not paid their workers for the last three months and expect that health care will be normal,” stated RUPHA Chairperson Brian Lishenga at a press conference on Monday.
Health CS Dr Deborah Barasa, with PS Mary Muthoni and Director General Dr Patrick Amoth, inspecting key health facilities, including KNH, to evaluate preparedness for the Mpox outbreak, Monday, August 19.
Photo
MoH
Last month, a survey by the organisation indicated that nine out of ten Kenyans still pay for medical services out of pocket, despite the government’s launch of the Social Health Insurance Fund (SHIF).
The survey, conducted between the 9th and 12th of this month, highlights significant challenges in the rollout of the SHA and SHIF, despite government assurances of comprehensive coverage.
However, the body now claims that the financial burden on patients and facilities has increased since the launch of SHA.
Adding to their frustrations, the government, which had promised to pay Ksh3,360 per day for Level 4 facilities, Ksh3,920 per day for Level 5 facilities, and Ksh4,480 per day for Level 6 facilities for patients in the ICU and HDU, is only paying Ksh75.
“Why is it that now the reimbursement for outpatient visits is Ksh75? How is it possible that you can provide x-rays, ultrasound, and laboratory tests within just 75 shillings per month? This is not the promise that we gave the Kenyan people,” added Lishenga.
The Ministry of Health on Monday confirmed that SHA’s coverage is based on tariffs that were gazetted in November 2024, which had indicated patients were required to top up any amount that exceeds the cover limit.
SHA, which has received a lot of criticism since its rollout in October, continues to face teething issues that have seen clinical officers threaten to down tools.
However, the government is not backing down, with President William Ruto and his government continuing to push for more Kenyans to register for the scheme.
President William Ruto delivers an address during the 11th National and County Governments Coordinating Summit at State House Nairobi, on Monday, December 16, 2024.
PCS