The Rural and Urban Private Hospitals Association (RUPHA) is demanding KSh 29 billion owed to them by the defunct NHIF, failure to which, patients seeking medical services in the hospitals will be forced to pay cash.
- •The association said that NHIF owed health care providers about KSh 15.8 billion in verified claims by 31st August – a figure that the Social Health Authority (SHA) has acknowledged as payable.
- •However, RUPHA also stated that there are 2.7 million NHIF claims that were unverified, which as per their records, amount to about KSh 14 billion – monies they have demanded have to be paid too.
- •In a press statement, the association said that 67% of private hospitals have defaulted the loans they have taken, citing the necessity of their demands.
“Unless there is a substantial move to settle NHIF liabilities, from 1st January, we will move to out-of-pocket payment. We have no other way. How do we keep the facilities open?” a representative of the association said.
RUPHA also stated that 75% of private hospitals were yet to pay their workers for the last three months. The private hospitals called out government officials for publicly trying to shame some private health facilities for denying SHIF claims.
“You cannot have three-quarters of hospitals that have not paid workers for the last three months and expect health care to be normal,” a RUPHA representative said.
“This is happening at the same point you’re telling Kenyans you’re free to walk into any hospital and walk out because healthcare is free. We need to be honest about the messaging,” he added.
The association of private hospitals also faulted the capitation amount allocated to primary health care providers under the Social Health Authority (SHA). They stated that it was insufficient to sustain operations, forcing them to demand higher out-of-pocket expenses from patients. A report they released also shows that 39% of hospitals did not receive payments from SHA in November, while 23% of those who received payments had reduced capitation amounts.
“Providers are grappling with acute financial distress, as delayed and insufficient payments from SHA undermine their ability to maintain operations and pay staff. The lack of transparency in payments is exacerbating the issue,” the report noted.
The December report released by RUPHA detailed grim perceptions of the new insurance scheme. It stated that 29% of hospitals had challenges accessing SHA’s system, up from 17% of hospitals in the November report. The transition score remains under the 50% performance.
“Challenges such as frequent portal downtimes, delayed payments, and inadequate training on the system hinder providers and patients, calling for urgent interventions,” the report said.
The report studied over 200 hospitals across Kenya, including private and public health facilities from Level Two to Level Five. Patient perception remains low with 67% of the patients faulting the transition amid claims of aggravated costs and insufficient coverage.
Meanwhile, the government insists that SHIF’s imperfections are as a result of ‘teething challenges’ that will be sorted out in the long run. It has urged MPs and other leaders to actively advocate for the health insurance scheme, blaming the discontent on ‘fake news’ and ‘fruitless negativity’.