SHIF cannot pay for my surgery, says stranded patient
The newly rebranded Social Health Authority building in Nairobi.
What you need to know:
- Under the now-defunct NHIF, the maximum contribution was capped at Sh1,700.
- With SHA, individuals are required to contribute 2.75 per cent of their household income.
In February this year, Samuel Kiraguri and his family were travelling home when they were involved in a tragic accident.
He lost his wife in the accident and the sister sustained severe injuries, including a fractured hand and jaw. She was taken to Kijabe Mission Hospital and surgery was scheduled. This was done in March this year and a metal rod was placed on her hand and in the jaw.
Through the National Hospital Insurance Fund (NHIF), she was able to receive treatment and had her medical bills covered. However, with the transition to the Social Health Insurance Fund (SHIF), Sam's family has encountered a serious problem.
Last week, her sister's hand started hurting, so she went back to the hospital for a check-up. She was told that the bone had healed well and that the metal rod should be removed. After several follow-up consultations, a surgery was scheduled.
The hospital stated that it was not accepting the Social Health Authority (SHA) system. The surgery goes for Sh450,000. The family has been presented with three options: pay cash, wait for SHA structures to cover surgeries, or use an alternative medical cover.
The family contacted SHIF’s customer care, they were informed that structures for covering surgeries were not yet in place.
“We were told that we either had to wait until these structures were established or pay out of pocket. What kind of mistake have we gotten ourselves into as a country? I am so disappointed. They deduct money from your salary but when you need the services, you still have to pay cash,” Sam said.
Under the now-defunct NHIF, the maximum contribution was capped at Sh1,700. However, with SHA, individuals are now required to contribute 2.75 per cent of their household income, a steep rise that is squeezing already strained finances.
Many Kenyans have felt that they are paying more for a system that is not yet fully operational and that it will take for the new scheme to function effectively.
With the pain, the family have since decided to look for alternative ways of having the surgery done. However, this unfortunate scenario raises pressing questions about the readiness of SHIF to take over from NHIF.
“For months of treatment, we relied on NHIF for our bills to be settled, we are now begging to be treated, the level of dysfunction has left many of us Kenyans helpless,” Sam said.
Patients, like Sam’s sister, are left in limbo, with no clear options for receiving timely and affordable care. The lack of proper structures has created a gap in service delivery, leaving vulnerable citizens stranded at a time when they need healthcare the most.
This is just one example of the many frustrations being felt by Kenyans across the country, as the promises of a better healthcare system under SHIF have yet to materialize.
According to the surgical benefit package, SHA will be reimbursing hospitals from as low as Sh3,000 for a topography to as much as Sh1,200,000 for the insertion of an artificial urethral sphincter.
Operative Hysteroscopy will cost Sh8,000, Arthrodesis Hip, Knee, Ankle or Elbow with implants at Sh168,000 and removal of bone plates at Sh89,600.
Doctors have also weighed in their frustration with many left without an option but to ask for help on social media.
On Friday, Dr Muli wrote on his X space how his patient needed a service that was not covered by SHIF while cursing on the SHIF system.
“I have a patient who I referred to Kenyatta National Hospital with a brain tumor (pituitary macroadenoma). The insurance they're provided with at his job has been exhausted on imaging. Now we need to do his pituitary hormone levels and SHIF can't help him. I join him in cursing whoever brought the idea,” he said
The update that attracted over 500 comments had Kenyans speaking about how frustrated they were with the transition that has since left them begging for services from hospitals.
“We are being forced to pay cash for services. It is okay, I may struggle to pay because I badly need the services but what happens once they start deducting my money, will they refund the money as they claim? This is a big joke, I feel so bad for those who need to be on treatment for life in this country,” Nyongesa Kimuye wrote.
One Agnes wrote: “We are facing this and the government is busy with unnecessary discussions. I registered for that SHIF the message came back, however, my name did not appear when I checked yesterday, I just wanted to be sure so that I am not shocked in case I get ill now. I cannot register again because I am being told I have registered yet hospitals cannot find me in the system. The worst time to be sick in Kenya.
Patients are now caught in a transition period where services that were previously covered under NHIF are either not guaranteed under SHIF, and if under SHIF, the amount is chopped and they have to dig deeper into their pockets.
The transition was to be a game-changer for Kenya's healthcare system, promising better coverage, easier access, and more streamlined services. However, for many patients, the reality has been a far cry from those promises, with an overwhelming sense of frustration and despair setting in as the system fails to meet their most basic healthcare needs.
Some hospitals, for instance, have refused to get into the new system until structures are in place. For instance, all four private dialysis clinics in Nakuru County are yet to be on boarded into the system citing frustrations.
“This is my hospital and I appreciate the fact that the government want to have a contract with us there are things that we need to align before we finally give in. The government still owe this hospital money and we just need that cleared,” said one of the hospital owners.
Health Medical Services Principal Secretary, Harry Kimtai mentioned that all the hospitals that were owed by NHIF will be paid by the current SHA.
