The Rural Private Hospitals Association of Kenya chairman Brian Lishenga.
Kenyans seeking services from over 600 facilities affiliated to the Rural and Urban Private Hospitals Association of Kenya (Rupha) will be stranded following the suspension of services from today.
Rupha leadership on Sunday issued guidelines to hospitals reminding them to only offer emergency services and treat patients who were already signed up before their directive. Non-emergency patients registered under the Social Health Authority (SHA), as well as teachers and police officers who use the Medical Administrator Kenya Limited (MAKL) will not be attended to unless they have alternative modes of payment.
The association also said patients who had been admitted before today will continue receiving care in hospitals under the existing terms. They advised that all facilities should track ongoing admissions and scheduled appointments to ensure smooth service continuity for affected patients. Speaking to the Nation on Sunday, Rupha chairperson Brian Lishenga said the government has not reached out to them to settle the ongoing dispute.
“We have tried reaching out to the government. I spoke to the Heath Cabinet Secretary and one of the principal secretaries. The CS mentioned that she will take the issue to the President, but we don’t know when that will be. The PS said they are ready to start reconciliation,” Dr Lishenga said.
He said that while reconciliation of unpaid claims had started, he was worried that some employees from the now defunct National Hospital Insurance Fund may be laid off, reducing the staff in branches that can help in reconciling all the claims.
The Social Health Authority building in Nairobi.
“What we don’t have is a concrete plan and we don’t have any structured talks that can lead to some agreements on the key issues. For instance, we have some claims that are not disputed and are already at payment stage. We can then have a reconciliation plan on the claims that still need to go through a process,” he said.
11 months of arrears
Dr Lishenga told the Nation that to this day, they have not had any commitment to police and teachers’ schemes. “They said they had released some money to MAKL, however, they have not settled the claims just yet. We have about 11 months of arrears; we don’t know whether they have cleared or whether they are planning to.
“If they reach out, then we can have a plan. As of now, we don’t want the payment plan to go beyond three months because most providers are using overdrafts and loans, and the longer that takes, the more the interest they will pay,” he said.
The association also wishes to get an audience with the Digital Health Authority on the SHA portal to share its feedback on provider training and awareness, as well as bugs that cripple the SHA system to reduce inconveniences that patients have to face.
It has now asked facilities to take a professional and procedural approach to notifying patients of the suspension of services under SHA and MAKL. “For pre-booked MAKL or SHA patients, hospitals should make efforts to call ahead at least 24 hours before the appointment to inform them of alternative payment options or referral pathways,” said Rupha, in a statement.
Financial hardship
Health ministry’s Principal Secretary for Medical Services Harry Kimtai sent a statement to newsrooms on Sunday, urging Rupha to reconsider its decision. “We encourage private healthcare providers to continue providing our beneficiaries with healthcare services focusing on a comprehensive approach to cushion Kenyans from financial hardship to achieve the government agenda of making healthcare available and affordable to all Kenyans.”
Medical Services Principal Secretary Harry Kimtai during an event on August 6, 2024 at Afya House.
He also sought to assure that reconciliation and verification of the claims owed to facilities was on course. “SHA, in liaison with the Ministry of Health, is working on obtaining funding for these claims. Hospitals that have yet to sign off the reconciliation are encouraged to do so to assist in confirming the true value of the authentic claims. Once reconciliation is completed and funds are available, SHA will clear the debts,” he said.
Kimtai acknowledged hitches in the SHA system especially in areas where there is no internet connectivity providing alternatives to healthcare providers.
“The ministry is introducing biometrics verification for all and testing is ongoing to reduce reliance on the One-time-password (OTP). To improve connectivity, the Government through the Ministry of ICT is providing alternative connectivity (through satellite),” he said.
“All facilities can now track their claims from the provider portal and the process is as follows: go to provider portal, click on the invoices, you will see all the invoices and claim status,” he explained.
Should RUPHA maintain their stance, stranded patients will be given three options; to either pay out of pocket, be referred to different facilities or use an alternative insurance provider apart from SHA or the teachers’ and police officers’ medical scheme.
The association leadership said that the structured suspension will ensure that patients are not abandoned, while protecting healthcare providers from financial collapse.
“RUPHA remains open to engagement if the government commits to resolving these issues. Until then, hospitals must prioritise financial sustainability and patient safety,” said Dr Lishenga.
hshikanda@ke.nationmedia.com
