Rural private Hospitals association of Kenya calls for urgent attention to Nhif payment crisis

Rural private Hospitals association of Kenya calls for urgent attention to Nhif payment crisis 

By Maximilla WAFULA & Patrick KIMANZI 

County Diary news 

The Rural Private Hospitals Association of Kenya (RUPHA), representing over 400 healthcarefacilities across the country today addresser  the ongoing crisis surrounding the National Hospital Insurance Fund (NHIF).

They have issued a 7-day notice of change in access to benefits for NHIF 

beneficiaries due to persistent breaches of contract by NHIF in meeting its financial obligations to healthcare facilities. Unfortunately, the NHIF has not made significant efforts to rectify the situation.

Over the past 8 months, NHIF has consistently failed to pay or underpaid for services rendered, 

with payouts for medical and surgical admissions ranging from 5-10% of valid claims. Contractual quarterly capitation payments for outpatient services have not been remitted for the OCT-DEC quarter, and the Linda Mama scheme has not made payments since June 2023. 

Preauthorization for cancer care has either not been approved or reimbursements drastically reduced.

As a result, many healthcare facilities are on the brink of closure, unable to guarantee crucial services such as outpatient, maternity, surgical, dialysis, and cancer care to NHIF beneficiaries. Employees face up to 3 months of salary arrears, and essential expenses like rent, utilities, and statutory deductions are in jeopardy.

At a Special General Meeting on the 19th of December 2023, healthcare providers

unanimously endorsed resolutions to ensure the continued availability of services to NHIF. Measures that will be implemented by the 

Starting of  December 20, 2023,  will ensure that 

NHIF patients will pay a fee of Kshs 1,000 to access outpatient services , NHIF patients requiring admission for medical cases will be requested to pay an 

admission fee,  NHIF patients requiring surgery will be requested to pay a theatre fee, NHIF patients receiving cancer care will be requested to pay a consultation fee, 

laboratory testing fees, and procedure fees for any interventions , NHIF patients on the Linda Mama scheme will be requested to pay a procedure fee 

for normal delivery and a theatre fee for Caesarean section,  RUPHA member facilities will continue to attend to NHIF beneficiaries in 

emergency and critical situations.

These resolutions will remain in effect until NHIF regularizes payments owed to healthcare facilities 

during its transition to the Social Health Authority (SHA). RUPHA opposes NHIF's transition to SHA without settling its liabilities with providers, and healthcare providers will not be party to a contentious transition.

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