Health PS Harry Kimtai addresses the media on Wednesday, October 30, 2024. Courtesy photo
Several Kenyan hospitals, including key facilities in Nairobi and Nyeri, are holding on to their current payment systems, resisting a full switch from the National Health Insurance Fund (NHIF) to the new Social Health Authority (SHA) model. This reluctance persists despite recent reassurances from Medical Services Permanent Secretary Harry Kimtai, who has promised that outstanding NHIF payments will be cleared by the end of the week.
The Ministry of Health’s SHA reform, which allegedly aims to improve healthcare access, has faced challenges in implementation. Under SHA, facilities are expected to provide care based on a simplified benefits structure, reducing discrepancies in service availability. Yet, many hospital administrators remain concerned over financial stability, citing the NHIF’s history of delayed disbursements.
A hospital manager, preferring anonymity, explained, “Switching to SHA without clarity on NHIF settlements would put our operations at risk.” According to reports, some hospitals are still owed millions in unpaid NHIF claims, prompting them to hesitate until a stable flow of payments is assured.
Financial Concerns and Operational Implications
With Kimtai’s pledge to settle the NHIF dues by week’s end, the Ministry hopes to ease tensions with hospitals. Nonetheless, administrators argue that immediate action is crucial to restore their confidence in government-backed health reforms. Hospitals rely heavily on NHIF reimbursements to fund operational costs and provide continuous care for patients.
Data from the Health Ministry reveals that NHIF disbursements cover nearly 40% of public hospitals’ operational budgets. Any delays, therefore, pose severe risks to service delivery. Kimtai stressed, “Our priority is to resolve these outstanding payments promptly. We are committed to ensuring that hospitals are not financially strained.”
Transition to SHA and Future Prospects
The new SHA scheme is intended to address long-standing inefficiencies in NHIF while establishing a single-payer system. SHA advocates claim that once implemented, the model will streamline patient access and ensure equitable healthcare provision. However, the hospitals’ reluctance to transition underscores their lack of trust in the government’s ability to manage claims consistently.
Public and private hospitals have also urged the Ministry to provide clear timelines for SHA implementation. “It’s a step forward in theory, but practical readiness remains questionable,” remarked Dr Timothy Ochieng, a healthcare analyst. Experts warn that without adequate funding guarantees, SHA may encounter the same pitfalls as NHIF.
Public Concerns and Impact on Patients
For Kenyans dependent on NHIF, this hold-up has raised concerns over potential service disruptions. Nearly 70% of Kenyans rely on NHIF to offset healthcare expenses, with coverage extending to over 20 million individuals. Patient advocates have called for transparent communication, expressing worry that the transition’s financial constraints could compromise care quality.
While Kimtai’s reassurances have mitigated some fears, stakeholders agree that immediate and tangible action is needed to build trust and secure cooperation from hospitals. For now, the healthcare system remains in a state of flux, with hopes that financial settlements can pave the way for a smoother transition to SHA.