NAIROBI, Kenya – Private hospitals in Kenya have announced they will stop offering credit services to patients beginning January 1, 2025, citing mounting debts owed by the government through the defunct National Health Insurance Fund (NHIF).
The hospitals, under the Rural and Urban Private Hospitals Association of Kenya (RUPHA), claim they are owed approximately Ksh29 billion, a financial burden that has left many on the brink of collapse.
RUPHA has accused the government of failing to address the unpaid NHIF liabilities and criticized the new Social Health Authority (SHA) funding model, which they say exacerbates the crisis by reducing capitation amounts.
“Unless there is substantial movement to settle the NHIF liabilities by January 1st, we will be forced to demand out-of-pocket payments,” RUPHA Chairperson Brian Lishenga said.
Lishenga painted a grim picture of the healthcare sector’s financial struggles, revealing that nearly 67% of hospitals are defaulting on overdrafts, 25% are tangled in small claims courts, and a staggering three-quarters have been unable to pay staff salaries for three consecutive months.
“You cannot have this level of debt and still expect healthcare to function normally,” he emphasized.
The situation has been worsened by what RUPHA calls “unrealistic” reimbursement rates under SHA, particularly for critical services like ICU and HDU care.
A circular from the Ministry of Health confirms that SHA tariffs allow reimbursement of: Ksh3,360 per day for Level 4 facilities, Ksh3,920 per day for Level 5 facilities, and Ksh4,480 per day for Level 6 facilities.
Patients must cover any costs beyond these rates. Lishenga pointed out the stark contrast between the government’s initial promises and the reality patients face.
“We were told ICU admissions would be covered up to Ksh45,000 for 14 days. Today, some Kenyans are receiving reimbursements of just 10% of their ICU bills,” he said.
Additionally, reimbursements for outpatient services, including X-rays, ultrasounds, and lab tests, remain critically low.
“How is it possible to provide these services for only Ksh75 per month per patient? This is not the promise we gave Kenyans,” Lishenga added.
The healthcare crisis has also drawn criticism from the Kenya Union of Clinical Officers (KUCO), which has accused the SHA board of sidelining clinical officers and their facilities from empanelment and pre-authorization processes.
In response, KUCO announced its members would boycott patients registered under NHIF until their grievances are addressed.
“The SHA board has deliberately excluded clinical officers. This goes against the principles of Universal Health Coverage (UHC),” KUCO officials stated, calling on President William Ruto to disband and reconstitute the SHA board.
With the looming January 1st deadline, patients seeking care at private hospitals face a harsh reality: cash-only payments.
This move could further limit access to healthcare for Kenyans who rely on insurance for medical bills.
RUPHA has given the government 14 days to resolve the crisis or risk further disruptions in healthcare services.
As the standoff continues, the fate of millions of Kenyans hangs in the balance.
The hospitals, under the Rural and Urban Private Hospitals Association of Kenya (RUPHA), claim they are owed approximately Ksh29 billion, a financial burden that has left many on the brink of collapse.
RUPHA has accused the government of failing to address the unpaid NHIF liabilities and criticized the new Social Health Authority (SHA) funding model, which they say exacerbates the crisis by reducing capitation amounts.
“Unless there is substantial movement to settle the NHIF liabilities by January 1st, we will be forced to demand out-of-pocket payments,” RUPHA Chairperson Brian Lishenga said.
Lishenga painted a grim picture of the healthcare sector’s financial struggles, revealing that nearly 67% of hospitals are defaulting on overdrafts, 25% are tangled in small claims courts, and a staggering three-quarters have been unable to pay staff salaries for three consecutive months.
“You cannot have this level of debt and still expect healthcare to function normally,” he emphasized.
The situation has been worsened by what RUPHA calls “unrealistic” reimbursement rates under SHA, particularly for critical services like ICU and HDU care.
A circular from the Ministry of Health confirms that SHA tariffs allow reimbursement of: Ksh3,360 per day for Level 4 facilities, Ksh3,920 per day for Level 5 facilities, and Ksh4,480 per day for Level 6 facilities.
Patients must cover any costs beyond these rates. Lishenga pointed out the stark contrast between the government’s initial promises and the reality patients face.
“We were told ICU admissions would be covered up to Ksh45,000 for 14 days. Today, some Kenyans are receiving reimbursements of just 10% of their ICU bills,” he said.
Additionally, reimbursements for outpatient services, including X-rays, ultrasounds, and lab tests, remain critically low.
“How is it possible to provide these services for only Ksh75 per month per patient? This is not the promise we gave Kenyans,” Lishenga added.
The healthcare crisis has also drawn criticism from the Kenya Union of Clinical Officers (KUCO), which has accused the SHA board of sidelining clinical officers and their facilities from empanelment and pre-authorization processes.
In response, KUCO announced its members would boycott patients registered under NHIF until their grievances are addressed.
“The SHA board has deliberately excluded clinical officers. This goes against the principles of Universal Health Coverage (UHC),” KUCO officials stated, calling on President William Ruto to disband and reconstitute the SHA board.
With the looming January 1st deadline, patients seeking care at private hospitals face a harsh reality: cash-only payments.
This move could further limit access to healthcare for Kenyans who rely on insurance for medical bills.
RUPHA has given the government 14 days to resolve the crisis or risk further disruptions in healthcare services.
As the standoff continues, the fate of millions of Kenyans hangs in the balance.
