Patients and beneficiaries of the National Health Insurance Fund (NHIF) seeking crucial medical services from private rural hospitals will be required to pay extra fees.
Notably, the move comes after the Rural Private Hospitals Association of Kenya (RUPHA) issued a threat on December 20 through a statement.
The association has since made true to its threat of halting the provision of some medical services to patients under the insurance cover.
According to the statement by RUPHA, this move comes following delays by the government to disburse funds for the last six months.
“We regret to inform you that due to persistent challenges in receiving payments from NHIF, RUPHA has been compelled to take certain measures to ensure the continued provision of essential healthcare services,” read the statement in part.
Extra Charges for NHIF Beneficiaries
In addition, the association noted that changes to access of services for NHIF beneficiaries would be effective.
Notably, according to the statement, for outpatient services, a fee of Ksh 1,000 will be required for NHIF patients seeking the services.
The statement further read, “Patients requiring admission for medical cases will be requested to pay an admission fee.”
On the other hand, crucial medical services such as surgery and cancer care will also be affected.
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Nevertheless, patients who require surgery using the cover will be requested to pay a theatre fee.
Furthermore, RUPHA added, “NHIF patients receiving cancer care will be requested to pay a consultation fee, laboratory testing fees, and procedure fees for any interventions.
The Linda Mama Scheme has also not been spared as patients on the scheme are expected to pay extra charges.
As such, expectant mothers are to pay a procedure fee for normal delivery and a theatre fee for Caesarean section.
However, for emergency and critical situations RUPHA member facilities will continue to attend to NHIF beneficiaries without any changes.
RUPHA Complaints
Rural Private Hospitals Association of Kenya (RUPHA) is an association of privately-owned medical facilities within the 47 counties of Kenya.
Furthermore, the Association regretted its decision, reiterating its previous calls to the government to disburse funds for a seamless delivery of services.
“As of 8th December 2023, and for the last 6 months, NHIF has failed to make the required payments to health facilities in strict compliance with the provisions of our Agreement,” stated RUPHA chairman Dr. Brian Lishenga.
Social Health Insurance Act
Notably, NHIF is set to be scrapped after the enactment of the Social Health Insurance Act, 2023 in November.
Health CS Susan Nakhumicha announced that the Act would see establishment of three new funds.
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The three new funds will include the Social Health Insurance Fund, Primary Healthcare Fund, and Chronic Illness and Emergency Fund.
Nakhumicha made the announcement in a gazette notice, paving way for planned reform in health financing.
Furthermore, according to the CS, the Act seeks to address issues that have faced the now defunct NHIF.
The gazettement further revealed that the Social Health Authority (SHA) will replace the National Hospital Insurance Fund.
“Any person who is eligible to be registered as a member of the national insurance fund will be required to produce proof of compliance to be allowed to access public services,” read part of the SHIF Act.
