Social Health Authority claims shoot up to Sh12m
Health Cabinet Secretary Deborah Barasa addresses journalists in Nakuru on the progress of SHA rollout.
What you need to know:
- About 1,442 health facilities have been contracted to deliver services to registered members.
Kenyatta National Hospital submitted the highest number of claims totalling Sh2.3 million for reimbursement under the new Social Health Authority (SHA) system within the past nine days, data from the SHA portal shows.
Since the scheme was launched on October 1, the SHA portal has received over 940 claims from more than 288 healthcare providers amounting to Sh12.4 million in the first nine days. This marked a significant rise, signalling an increased adoption of the system despite the ongoing challenges.
Inpatient claims account for the bulk of the costs, with 343 claims totalling Sh7.2 million, while outpatient claims reached Sh5.2 million from 567 submissions. Of the submitted claims, the government has paid Sh1.5 million for 94 claims.
Kenyatta National Hospital leads with 87 claims, while Rapha Dialysis and Diagnostic Centre follows closely with 60 claims totalling Sh682,000.
Cure and Cure Hospital has submitted 37 claims worth Sh626,000, and other facilities like Tophill Hospital in Eldoret, PCEA Chogoria Hospital, Ladman Hospital, and Tenwek Hospital have also made substantial claims ranging from Sh362,000 to Sh534,000.
Despite these figures, many hospitals have reported difficulties accessing the SHA portal, leading to delays in submitting their claims. This has affected the timely launch of claims, raising concerns about the system’s readiness and efficiency in handling the transition.
Already, according to the SHA account, about 1,442 health facilities have been contracted to deliver services to registered members.
Numerous health facilities, which are expected to provide services under the new scheme have reported that they are unable to access the SHA system, making it difficult to process patients’ information or claims.
The technical glitch is not just a minor inconvenience, it has left many healthcare providers in a bind, unable to serve patients properly and casting doubt on the system’s preparedness for such a large-scale transition.
As of Friday, many facilities reported that they were unable to access the platform. This has left them unable to process claims or register patients effectively. Even worse, patients who have registered with SHA found their names missing from the system, thereby denying them services.
“For a health plan meant to cover millions, this oversight has caused chaos and confusion, with patients being forced to pay out-of-pocket for services that should have been covered under SHA. We need to make it work or drop it,” Kenya Medical Practitioners and Dentists Union (KMPDU) Secretary-General Dr Davji Atellah said.
One of the administrators at a leading private hospitals said: “Just because we are contracted by NHIF does not mean we are contracted by SHA. We have several concerns about this scheme and need answers before we participate. We will not get involved in something that will not work for our rates.”
On October 1, the National Health Insurance Fund (NHIF) ceased to exist and a new era was ushered in when SHA took effect. SHA manages three distinct funds: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency and Chronic Illness Fund. Individuals are expected to pay 2.75 per cent of their household income into the SHIF fund, while the government will fund the other two.
Renal Society of Kenya President John Gikonyo told Sunday Nation that the problem with the system could be bigger than the government thinks.
“It’s true that in some hospitals the system is working, however, in others, it is so much affected. We have had to ferry our patients from one hospital to the other in search of health care. Why do we need to do that if this thing is working everywhere?” He asked.
Mr Gikonyo said that some hospitals in Nakuru County are not offering services, including all four dialysis centres, and patients are being asked to pay cash.
A survey done by Rural Urban and Private Hospitals Associations shows only 40 per cent of private hospitals have fully transitioned to the SHA portal.
