Private Hospitals To Demand Extra Cash Payments From Patients As NHIF Fails To Remit Funds

• The Rural Private Hospitals Association of Kenya (RUPHA) accused the National Hospital Insurance Fund Board of failing to fulfil its obligations
• RUPHA said patients would be required to make top-up cash payments to access services from Friday, December 15, due to NHIF’s failure
• RUPHA claimed that for the last six months, the board has failed in its obligations with various claims and schemes

Didacus Malowa, a journalist at TUKO.co.ke, brings over three years of experience covering politics and current affairs in Kenya.

Nairobi - The Rural Private Hospitals Association of Kenya(RUPHA) has accused the National Hospital Insurance Fund (NHIF) Board of Management of failure to fulfil its obligations outlined in the agreement with healthcare providers.

In a statement by the Executive Committee chairman Brian Lishenga, RUPHA stated that patients would be required to make top-up cash payments to access services from Friday, December 15, due to the failure by NHIF.

:As a result of the Board's failure to honor its financial commitments, health facilities are left with no other recourse but to issue immediate notice that beneficiaries of the NHIF Schemes will be required to make TOP-UP cash payments in order to access services, effective from 15th December 2023," read the letter seen by TUKO.co.ke.

Lishenga added that the step was necessary to ensure quality healthcare service was being rendered to their clients.

What has clauses of contract has NHIF board breached

He accused NHIF of violating clauses 1.3.1 and 12.8 of the agreement with providers that give directives on how to operate.

According to clause 1.3.1, the board undertakes to pay to the health facility, for a beneficiary of the national scheme, a capitation amount of KSh 1,000 per beneficiary per annum within the first 30 days of the capitated period.

In clause 12.8, the board is expected to make payments to the health care provider for services covered under the Fund’s various schemes following the schedules of this agreement on a timely basis, but in any event, clean claims shall be paid within 90 days of receipt of the claim from the health care provider.

RUPHA disclosed that for the last six months, the board has failed in its obligations with surgical claims, outpatient capitation, Linda Mama, Edu Afya Medical Scheme and Claims in the suspended E-Claims system since 2019, most affected.

"It has come to our attention that as of 8th December 2023 and for the last 6 months, the Board has failed to make the required payments to health facilities in strict compliance with the provisions of our Agreement," Lishenga added.

Court suspends implementation of Social Health Insurance Act

Elsewhere, Justice Chacha Mwita ordered the state to cease the implementation of the Social Health Insurance Act.

In his petition to the court, Businessman Joseph Aura claimed that the Act would violate Kenyans' privacy rights, exposing them to more online harm.

He termed the Act unconstitutional and a gross violation of human rights, as it would deny unregistered citizens access to government services.