Hospitals uphold SHA suspension despite State's pledge to clear debt

Medical Services PS Harry Kimtai when he appeared before the National Assembly Health Committee in Nairobi, on February 19, 2025. [Elvis Ogina, Standard]

Private hospitals have remained firm on their decision to suspend Social Health Authority (SHA) cover services, despite the Ministry of Health’s pledge to verify claims before processing payments.

This comes even after a meeting between the hospitals and the Ministry of Health aimed at resolving the suspension, which has left patients without access to care.

Rural-Urban and Private Hospitals Association (RUPHA) vice chairman Joseph Kariuki insisted the hospitals will continue withholding services for SHA beneficiaries.

“The suspension of SHA services remains in place,” said Kariuki.

Some hospital representatives expressed disappointment with the meeting’s agenda. “The discussion was completely different from what we expected,” said a hospital owner who did not want to be named.

The meeting, convened by Principal Secretary for Medical Services Harry Kimtai, brought together representatives from RUPHA, the Kenya Association of Private Hospitals (KAPH), and faith-based organisations (FBOs).

The hospitals are demanding payment of Sh30 billion in arrears owed by the defunct National Health Insurance Fund (NHIF).

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But Kimtai said the meeting was not meant to discuss the pending bills, but to deepen hospitals’ understanding of the payment mechanism for outpatient services at the primary healthcare level.

In an interview with The Standard, Kimtai acknowledged a debt owed to private hospitals and promised to have it cleared.

The payments, however, will be dispersed as per circular issued by the National Treasury.

“The Ministry will pay the debt, but we need to have a verified report, as per The National Treasury circular to know how much we are paying, and who we are paying,” said Kimtai.

He said a technical team had been tasked to reconcile hospital claims from July 30 to September 30, 2024.

As per time of transition from NHIF to SHA last year, estimated total verified and unverified claims was Sh30 billion, of which Sh19 billion had been verified for payment.

Payments made in October and September last year were Sh8.6 billion, with outstanding verified debt being Sh10.4 billion.

As of February, verified claims have increased to Sh24 billion.

“We are reconciling all claims to know the exact amount of money being paid to the hospital,” said Kimtai.

The PS maintained that the agenda of the meeting was on Global Budget Payment, which entails outpatient reimbursement and SHA visibility.

“We agreed that a technical team will sit down with them through the reimbursement model, including how it works. There is an information gap,” said the PS.

Global Budget Payment model will provide hospitals with statements on what is being paid for, accepted and rejected claims, including outstanding claims, improving efficiency and transparency.

The model is aimed at ensuring hospitals are paid as per services discharged.

“We want to know if these facilities have served patients because we do not want to give reimbursement when you have not served patients,” said Kimtai.

RUPHA chairperson Dr Brian Lishenga noted that SHA beneficiary was reimbursing Sh900 per annum or Sh75 per month, an amount, he said, was unrealistic.

“Global Budget Payment is a model. It is an assurance. We want hospitals to understand it so that they do not go confusing members of the public,” said Kimtai.

He sought to assure stakeholders of the availability of funds for primary healthcare and reiterated the Ministry’s commitment to addressing concerns promptly.

“We value these engagements and will ensure stakeholders’ views are considered. The Ministry of Health is committed to taking positive action,” he said.