The Rural and Urban Private Hospitals Association (RUPHA) has stated that beneficiaries of the Social Health Authority (SHA) insurance scheme will have to pay cash across 700 private and faith-based hospitals to receive medical services until the government addresses their concerns.
- •In a press statement on Monday, the hospitals rallied against Health Cabinet Secretary Aden Duale’s decision to reject medical claims worth KSh 10.6 billion without following due process.
- •According to the provider contract with SHA, the authority is supposed to communicate within 14 days why they rejected a claim, but the delay of the pronouncement denied some providers clarification thus facing losses.
- •RUPHA noted that private hospitals were owed KSh 43 billion, with an additional KSh 24 billion under review, yet the scheme could only garner up to KSh 6 billion a month — mostly from salaried employees.
RUPHA also stated that the process of settling claims was done in a discriminatory manner creating inequity and uncertainty in disbursements. The association also claimed that the government had weaponized the war on fraud by arbitrarily rejecting legitimate claims. It faults SHA for failing to establish the Dispute Resolution Tribunal as mandated by law, locking up opportunities for dissatisfied providers to seek redress.
In its list of demands, RUPHA has also opposed plans to move teachers and police officers’ medical schemes from MINET until it covered its arrears to the defunct NHIF.
The Tech Investments
The private hospitals association also blames SHA for sinking billions of shillings into questionable tech projects meant to detect fraud. The agency’s flagship eClaims system, meant to block ghost facilities, has instead rejected valid claims while paying out phantom ones, costing an estimated KSh 5 billion.
A new “Track and Trace” pharmaceutical system, unveiled this week at a price tag of KSh 2.5 billion, comes alongside a KSh 2.46 billion drug utilization review plan, despite the collapse of past initiatives.
Meanwhile, a promised KSh 1.58 billion quality management system has yet to materialize, and KSh 7 billion earmarked for training and customer support has largely gone to Zoom and Teams sessions with no evidence of capacity-building in public hospitals. The spending spree raises questions by health care providers about the fidelity of the scheme even as government constantly points to cartels in the health sector.
Moreover, the private hospitals insist that the authority is yet to settle KSh 10 billion in verified claims dating back to the NHIF. They have stated that verification of providers’ claims worth KSh 10 million should begin within seven days and payments made instantly. According to RUPHA, 465 medical facilities had claims valued over KSh 10 million by September last year, with 82 facilities accounting for KSh 15 billion of the pending payments.
RUPHA has also faulted the downgrades of various health care providers, with almost 3,500 maternity beds lost and over 1,000 delivery beds erased on the SHA database. These arbitrary actions have seen service delivery affected in mostly rural counties like Mandera, Turkana, Wajir, and Garissa.
The association has added that if these demands are not addressed, Kenya’s dream of Universal Healthcare will collapse because private hospitals are a crucial backbone to this endeavor.
