By Billian Fatima
Over 600 hospitals in Kenya, under the Rural-Urban and Private Hospitals Association of Kenya (RUPHA), have announced plans to suspend services under the Social Health Authority (SHA) insurance scheme, citing unpaid arrears exceeding KSh 30 billion.
RUPHA Chairman Brian Lishenga stated that the suspension would take effect on Monday, February 24, due to unfulfilled obligations by the government. He revealed that 54% of hospitals had not received payments from SHA, 89% of facilities reported issues with the SHA interface, and 83% of hospitals faced significant challenges in confirming patient eligibility because of SHA's system errors.
Lishenga accused SHA of inefficiencies and ignorance in resolving existing challenges, stating that prolonged system outages, One-Time Password (OTP) verification delays, and the inability to monitor claim approvals have worsened in the last month. He added that hospitals are experiencing bank defaults, running low on crucial medications, and many consultants have not been paid for years, with unpaid debt dating back to 2017.
In addition to suspending SHA services, RUPHA declared it would no longer offer services under Medical Administrator Kenya Limited (MAKL), the medical administrator that manages teacher and police medical programs. Lishenga warned that teachers and police officers would be left without access to high-quality healthcare services if immediate action is not taken.
The association is demanding that the government settle the KSh 30 billion NHIF arrears in full and revise the SHA outpatient reimbursement model to ensure facilities are adequately compensated. They also call for fair and timely payments under MAKL for police officers and teachers.
This development has raised concerns about the potential impact on patients, particularly teachers and police officers, who may face challenges accessing healthcare services if the suspension proceeds as planned.
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