Doctors now accuse insurance firms of undermining healthcare

KMPDU Secretary General Davji Atellah. [File, Standard]

Doctors have faulted insurance companies for interference in healthcare delivery, accusing them of acting like “chief controllers” of the system.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) Secretary General Davji Atellah has said insurers are overstepping their mandate by dictating where patients should seek treatment, which doctors they should consult, and even which tests and drugs should be administered.

“This is wrong, unethical and illegal. A patient has the right to choose any hospital or doctor they feel will help them. Insurance companies have no business determining what tests or treatments a patient should receive,” said Dr Atellah. 

The doctors say insurers have increasingly restricted access to healthcare by refusing to authorise certain procedures, delaying payments to hospitals, and blacklisting facilities.

In Eldoret, the union noted, a patient scheduled for a procedure at War Memorial Hospital died after delays caused by insurance restrictions. “They have grown bolder. Recently, they even united to direct patients not to seek services at Nairobi Hospital. No hospital will be safe if their appetite for profit continues,” warned the union official.

Last week, at least 12 insurance firms suspended services at Nairobi Hospital, alleging a hike in charges for diagnosis and treatment. The hospital said the move was because of high cost of medical and pharmaceutical commodities. Insurance firms maintained they cannot cater to the hiked tariffs and further directed their clients to seek care in other hospitals.

Insurance firms are also accused of interference in Vihiga, Kiambu and Trans Nzoia among other counties. The insurance controversy comes amid a broader crisis, as the health sector caucus, comprising unions representing doctors, nurses, clinical officers, laboratory technicians, and other health professionals, has highlighted critical challenges threatening the country’s healthcare system.