Government to refund patients who paid own fees during SHIF rollout

Health CS Deborah Barasa (center), PS Medical Services Harry Kimtai (left) and  SHA Chairperson Dr Abdi Mohamed before National Assembly's Health Committee to discuss the rollout of the   Social Health Insurance Fund (SHIF) in preparation for the Universal Health Coverage launch on 1st October 2024 [Elvis Ogina, Standard]

The government has announced that patients who paid for healthcare services out-of-pocket since the rollout of the Social Health Authority (SHA) began will be refunded.

The announcement comes amid persistent confusion and frustrations across the country, with patients encountering challenges while trying to access services that were previously covered under the now-defunct National Health Insurance Fund..

“All patients who have paid out-of-pocket, reach out to us, and we shall refund,” said Dr Abdi Mohamed, the chairman of SHA.

The challenges, according to SHA, are linked to the transition from NHIF to SHA, which is in its seventh day. Under the SHA, registered beneficiaries are entitled to free primary healthcare services at level two dispensaries, level three health centres, select level four hospitals, and emergency services at all health facilities.

However, delays in contract renewal with certain private and faith-based hospitals have led to gaps in service provision.

“All public hospitals, from level two to six, have been contracted and are offering services to SHA-registered beneficiaries. As of today, 1,442 private and faith-based health facilities have returned newly signed contracts and are now providing services,” said Mohamed.

Mohamed was speaking in Nairobi after a consultative meeting with the representatives of private and faith-based healthcare providers.

To ensure that healthcare services remain accessible during the transition, SHA has set a deadline for the healthcare providers to return signed contracts by Tuesday this week.

Mohamed also stated that service providers have committed to ensuring continued access to care for SHA beneficiaries during the period.

To address the issue of pending bills, the government has formed a committee chaired by the principal secretary for medical services, Harry Kimutai, which will focus on fast-tracking the settlement of outstanding bills owed to healthcare facilities.

Kimutai acknowledged that pending bills have been a significant issue, straining the resources of service providers.

“The resources of service providers are dwindling, and they are struggling to cope with additional patients seeking care at their facilities. We are moving swiftly to clear these pending bills to support the facilities in providing uninterrupted service delivery,” he said.

Dr Brian Lishenga, the chairperson of the Rural and Urban Private Hospital Association of Kenya, said the settlement of pending bills is not only a sign of goodwill, but is essential for them to be able to provide services.