More than half of private hospitals yet to register on SHA portal
Pedestrians walk past the rebranded Social Health Authority (SHA) building in Nairobi on October 1, 2024.
What you need to know:
- Only 75 per cent of the transitioned private hospitals are able to access the Social Health Authority system.
- SHA capitation, e-contracting, billing, and financial burden cited as the worst-performing in the transition process.
Only 42 per cent of private hospitals in the country have fully transitioned to the Social Health Authority (SHA) portal, leaving a majority of the premium health facilities out of the new insurance plan.
A survey conducted by the Rural Urban and Private Hospitals Associations (RUPHA) on Thursday indicated that 75 per cent of the transitioned private hospitals are able to access the new system, whose rollout has been characterised by technical hitches.
RUPHA has rated the success rate for registration and patient verification at 50 per cent, adding that incorrect details of family member registration remains a problem.
Lack of formal training in pre-authorisation and claims management for surgical patients, as well as pre-approval for emergency and maternal health cases, are among the key factors holding back the ongoing transition from the National Health Insurance Fund (NHIF) to the SHA, the report states.
The inaugural scorecard report released by RUPHA shows that pre-authorisation is still disabled for most services, except for renal treatment, and that the benefits list has not been fully uploaded.
The report highlights SHA capitation, e-contracting, billing, and financial burden as the worst-performing in the transition process. These sectors scored 30 per cent, highlighting the need for urgent attention to ensure a smoother transition and continuity of care for patients.
The Status report provides an assessment of the ongoing transition from NHIF to SHA as of October 9, 2024. It outlines the key issues being tracked and assesses SHA performance on a scale of 0-100 per cent, along with a grade (A-E) to reflect progress and effectiveness in addressing these issues.
“The transition has introduced several challenges in system access, claims processing, capitation, and financial management for healthcare providers. This assessment highlights areas of improvement and those requiring urgent attention to ensure a smoother transition and continuity of care for patients,” said Dr Brian Lishenga, RUPHA chairman.
The report shows that as of October 6, less than 10 per cent of healthcare providers were able to complete electronic contracts due to website errors. This contradicts an earlier report from the SHA which claimed that 95 per cent of problems had been resolved. The website remains unavailable to all providers, affecting service delivery for all but those previously contracted to the NHIF, but not for non-NHIF providers.
With regard to the capitation model, the technical working group has completed three out of 10 tasks, including setting up, drafting a proposal and holding the first meeting. However, tasks such as identifying hospitals, redistributing patients and disbursing funds are still outstanding.
In terms of billing and financial burden, the financial burden on hospitals continues as the joint committee set up on 6 October has yet to meet to address the challenges.
In terms of claims submission and management, the report shows improvements in dialysis claims processing, but not for other services. Problems with billing and coding persist.
Providers with login credentials can bill for emergency and maternal health services. There are also concerns about system functionality, with some hospitals unable to access the system. In addition, technical difficulties are causing problems with patient premium payments, which could lead to lapses in coverage.
Earlier in the week, a survey conducted by the SHA's Engagement Forum on 7 October, which was designed to gather real-time feedback from providers on the progress of the transition, revealed that hospitals were experiencing difficulties logging into the system, pre-authorising claims and admitting patients.
The SHA Healthcare Providers Consortium survey shows that 64 per cent of providers did not have credentials to log into the SHA system, meaning that none of the providers were able to visit and treat a patient in the new system.
The SHA has experienced challenges with its digital claims processing systems. As a result of these setbacks, providers had to resort to manually filling out claims forms. This change was prompted by protests from providers who had difficulty accessing the system.
The SHA initially integrated two digital claims processing systems, Apeiro from a subsidiary of an Abu Dhabi-based investment firm and eOxegen from India. However, both systems failed to perform after the SHA went live on October 1.
The latest system, developed by Savanna Informatics, also had security flaws, highlighting significant problems with the security of Kenyans' contributions.
