Patients pay bills in cash as chaos persists
SHA Chairman Abdi Mohamed, PS Harry Kimtai and Rural Private Hospitals Association of Kenya Chairman Brian Lishenga speak to reporters on October 6, 2024.
What you need to know:
- Because the Ministry of Health has not issued guidelines for the refunds, patients do not know where to submit receipts or complaints, the timeframe for refunds and many other details.
- Many hospitals and clinics are not fully integrated into the SHA system, complicating matters for patients, their families and hospitals.
- With no clear instructions from the government, hospitals continue to demand cash from patients as they are unsure when the system will stabilise.
Patients are still being asked to pay cash for treatment as confusion over the Social Health Authority (SHA) continues.
The government has yet to honour its promise to reimburse those who have paid out of pocket for health services since the SHA was introduced last week.
Because the Ministry of Health has not issued guidelines for the refunds, patients do not know where to submit receipts or complaints, the timeframe for refunds and many other details.
Mr George Ndung'u and another patient sent their hospital receipts to the Daily Nation on Tuesday.
The receipts show that the two were forced to pay cash even after SHA Chairperson Abdi Mohamed said they would be refunded and urged people to contact the authority.
“When I arrived here, I was told that the Valley Spring Hospital portal was not active and that the institution could not offer services using SHA. The hospital demanded that we part with cash,” Mr Ndung’u said.
“I paid Sh9,500 for the dialysis session. I arrived at the hospital at 7am and my session began at noon as we were waiting for the approval that never came.”
The process, which replaced the National Health Insurance Fund (NHIF), has left millions of Kenyans unsure of whether they will be reimbursed, where to file complaints or even where to send their medical receipts.
Dr Mohamed said Kenyans affected by the transition who had spent money on medical services would be refunded. He did not give a date.
The SHA chairman added that a committee of health providers and government representatives, chaired by Medical Services Principal Secretary Harry Kimtai, would be set up to review bills incurred by patients during the transition period.
“We have committed to healthcare providers to prioritise the bills accumulated during this transition. As a result, there will be frequent consultations,” Dr Mohamed said.
Ms Emily Gorrety, another patient, said she did not know who to contact with complaints and questions.
“Who is the go-to person at the authority? Who do we give the receipts and how long will families wait for the promised refunds?” Ms Gorrety asked.
“These issues need to be cleared by the authority before the programme proceeds. Families are still digging deep into their pockets and yet the government will still make deductions from our pay.”
She added that the government was not being clear as all announcements were being made at press conferences.
“Whatever is happening to patients is different from whatever media houses are being informed. Why are Kenyans being subjected to this confusion? Why launch a system in such a hurry when structures are not even in place?”
She expressed fears that just as the government has no structures in place during the rollout, there will be no clear mechanisms on refunds, leaving millions of people confused, frustrated and penniless.
Mr Ndung’u added, “I paid for my dialysis in cash after being told that the new system was not fully operational. No one has come to explain to me how and when I will get the money or where to file the claim.”
Many hospitals and clinics are not fully integrated into the SHA system, complicating matters for patients, their families and hospitals.
With no clear instructions from the government, hospitals continue to demand cash from patients as they are unsure when the system will stabilise.
This is despite assurances from the health authorities that everything will run smoothly.
“The absence of a well-communicated plan for refunds adds to the mistrust people have in our public healthcare system. This is the confusion we were talking about. I wish they listened to us,” said Davji Atellah, the secretary-general of the Kenya Medical Practitioners and Dentists Union (KMPDU).
He asked the government to get serious about the health of millions of Kenyans.
“How do you expect families to get refunds when many do not even have the money? We are killing our people. Until the government clarifies the refund process, citizens remain trapped in a system that burdens them financially. They are also in the dark on how their health expenses will be managed,” Dr Atellah told the Daily Nation.
The situation raises concerns about the ability of SHA to deliver on its promises to improve access to healthcare for all.
SHA Chief Executive Office, Elijah Wachira, said the authority would pay outstanding cases for which the NHIF had made a commitment before October 1, the day SHA came into effect.
“Patients whose admissions or procedures commenced after September 30, 2024 will have their bills settled under SHA. There is no lacuna,” Mr Wachira said.
He told patients and families who had already spent more than their SHA allowance not to worry. Earlier, questions had been raised about the readiness and capacity of the system, with hospitals that need to provide services left without access.
Missing patient names and problems processing claims in the first few days of operation suggest a lack of readiness for such a large-scale transition.
Despite the confusion and suffering, the Ministry of Health says the SHA system is fully operational.
It says some 1,442 private hospitals and 4,760 public hospitals have signed up, with 51 cancer care providers and more than 100 renal care units offering the services.
“We are pleased to confirm that the SHA claims system is fully functional. Training for health facilities on the claims portal has begun and will continue throughout the week,” Mr Kimtai said in a statement.
