Private hospitals under the Rural and Urban Private Hospitals Association of Kenya (RUPHA) have officially resumed services under the Social Health Authority (SHA) insurance scheme after the government pledged to clear outstanding arrears owed by the defunct National Health Insurance Fund (NHIF).
In a statement released Thursday, RUPHA Chairman Brian Lishenga confirmed that following extensive discussions, the association had decided to end the service suspension that began on February 24. The initial boycott was sparked by unresolved NHIF arrears, an impractical outpatient reimbursement model, and a lack of government intervention in addressing systemic inefficiencies.
The breakthrough came after State House announced that all hospitals with pending claims of Ksh10 million or less would receive full payments immediately. According to the government, this accounts for 91% of the facilities previously contracted under NHIF. Larger hospitals with claims exceeding Ksh10 million will undergo a verification process over the next 90 days before a payment plan is finalized.
While the move is seen as a positive step, RUPHA remains cautious, emphasizing that it will closely monitor the government’s implementation of these commitments. "This resolution does not address all concerns, but it marks a critical step towards alleviating the financial distress that private healthcare providers have been facing," Lishenga noted.
However, the association clarified that the suspension of services under Medical Administrator Kenya Limited (MAKL) remains in effect. According to RUPHA, MAKL has failed to reconcile outstanding debts owed to providers and has not been issuing remittance advice for payments made to hospitals, making it difficult for facilities to track their finances.
Lishenga warned that if hospitals owed more than Ksh10 million do not receive an initial payment soon, RUPHA will escalate the matter to Parliament to advocate for fair budgetary allocations. Additionally, should the claim verification process exceed the 90-day timeline, the association may reconsider industrial action to push for a resolution.
As the situation unfolds, the healthcare sector will be watching closely to see whether the government follows through on its commitments and whether the long-standing issues between healthcare providers and insurance administrators will finally be resolved.
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