The government is struggling to ensure that National Health Insurance Fund (NHIF) transits to the Social Health Insurance Fund as soon as possible amidst public outcry over the slow process.
The government has pledged to pay hospitals the Sh30 billion owed by the now-defunct National Health Insurance Fund (NHIF) as part of the ongoing shift to the Social Health Insurance Fund (SHIF). This move is critical in maintaining the trust of healthcare providers during the transition to SHIF. Last week, Sh1.5 billion was released, with an additional Sh3 billion scheduled for disbursement this week. The remaining balance will be settled gradually, subject to the availability of funds.
Hospitals and healthcare providers had expressed reluctance to transition to the Social Health Authority (SHA), citing the financial burden caused by NHIF’s unpaid claims. These outstanding debts have posed operational challenges for many facilities, with some forced to delay services or seek alternative solutions to continue operations.
The government has reassured stakeholders that the pending financial obligations will be addressed as part of the transition process. However, concerns remain over the payment timeline and whether SHIF will avoid the same financial pitfalls as NHIF, such as delayed claim processing and inadequate reimbursement rates.
Government Response to Hospital Concerns
Medical Services Principal Secretary Harry Kimtai acknowledged the hospitals’ concerns, stating that the government would take on NHIF’s assets and liabilities, which amount to approximately Sh30 billion in debt. He confirmed that the Health Ministry has formed a transition committee to oversee the process, ensuring that funds are disbursed equitably across healthcare providers.
Kimtai explained, “We’ve already released Sh1.5 billion and plan to release another Sh3 billion this week. A committee has been established to manage claims payments, and hospitals will receive funds based on the percentage of available resources to prevent carrying debts into the new system.”
Looking ahead, Kimtai reassured stakeholders that the new system would prevent payment delays. He said that as of now, the system has captured Sh100 million in claims, which will soon be paid to hospitals. Additionally, he instructed the SHA to process all claims within 90 days of submission, aiming to restore confidence in the system.
Dialysis Clinics Demand Debt Settlement
Dialysis clinics nationwide have been particularly vocal, demanding that NHIF settle its Sh10 billion debt before transitioning to SHIF. Some clinics have refused to join the new system until their outstanding payments are cleared. Hospital administrators have raised concerns that no formal mechanism exists to address this substantial debt, which has forced several dialysis units to close.
“We have worked with NHIF for over two decades to provide care for patients with kidney disease. However, we’re deeply concerned about NHIF’s failure to adjust reimbursement rates and fully remit claims,” said Dr. Jonathan Wala, chair of the Kenya Renal Association. He warned that the NHIF’s debt is jeopardizing access to essential dialysis services.
Challenges with the SHA System
As the country transitions to SHIF, both hospitals and patients are facing significant challenges. Under the old NHIF system, the maximum contribution was Sh1,700, but under SHA, individuals now contribute 2.75% of their basic salary or household income. Hospitals are also struggling to access the SHA system, with many facilities reporting difficulties onboarding and processing claims.
Several healthcare providers have reported that the system has been down since registration began earlier this week, preventing them from registering patients or processing claims. Additionally, some patients who registered with SHA found their names missing from the system, leaving them unable to receive healthcare services.
The cost of implementing the SHA system has also come under scrutiny. The new system reportedly cost taxpayers Sh104 billion, a figure significantly higher than the estimated Sh700 million it would have cost to upgrade the existing NHIF system. Lawmakers have raised concerns over the lack of public participation in the decision-making process and the high costs associated with the transition.
SHA’s Future in Question
The transition from NHIF to SHA has been marred by confusion and delays, with both hospitals and patients bearing the brunt of the challenges. Many Kenyans are frustrated, feeling that they are paying more for a system that is not fully operational. As system failures continue to disrupt services, the success of SHA remains uncertain, and stakeholders are anxiously awaiting improvements.
This transitional period is critical for the government to prove that SHIF can deliver on its promises of improved healthcare access and efficient claims processing, ensuring that hospitals and patients alike can benefit from the new system.
