An association of rural and urban private hospitals has pointed out that the Social Health Authority (SHA) will need to improve to ensure that the new insurance model, SHIF, will function effectively, ranking the transition from NHIF as below average (42%).
- The Rural and Urban Private Hospitals Association of Kenya (RUPHA) reported that SHA performed poorly in charting an elaborate capitation model and had not yet identified how it would disburse funding to hospitals.
- The association also accused SHA of being complacent and unresponsive to the billing challenges that have persisted thus leaving desperate patients to pay from their pockets. SHA has also scored poorly in servicing its e-contracting portal, which the association has blamed for being unavailable and technically problematic thus preventing many healthcare providers who were not contracted by NHIF from onboarding the new system.
These three issues scored an ‘E’ based on the association’s assessment. Other pertinent issues that SHA needed to streamline included sorting out location data errors, pre-authorization procedures, and challenges for patients in paying premiums. All of these issues scored ‘D’.
RUPHA noted, however, that claims submission and management had improved especially for dialysis services. This could largely be attributed to the intensity of media reports about patients who have been turned away from hospitals or forced to pay thousands of shillings to access a service that NHIF covered.
Patients’ registration as well as addressing emergency and maternity services also scored averagely. The only notable success SHA had made, according to the association, is that most hospitals have received login credentials and system access (scoring a B).
SHIF, which replaced NHIF on 1st October, continues to face acceptability challenges from Kenyans. The High Court will in the next two weeks decide whether to quash SHIF’s implementation. In a Thursday ruling by Justice Bahati Mwamuye, the defendants were asked to submit their responses to a lawsuit filed by Busia senator Okiya Omtatah, Eliud Matindi, and Dr. Magare Gikenyi.
The petitioners cited the absence of a subsidiary legislation needed to operationalize the Social Insurance Health Act. They also challenged the state’s decision to directly award a Safaricom consortium with a KSh 104 billion contract to create a health information system.
SHA has stated that about 12 million have been registered on its platform. However, what they actually did was automatically transfer those registered with NHIF to the new scheme. Many Kenyans complained that such an action was done without consent and have sworn not to update their status as prescribed.
