9 out of 10 Kenyans Still Pay Out of Pocket for Healthcare Despite SHA Transition

The healthcare system in Kenya is facing a significant challenge, as highlighted by the recent report from the Rural and Urban Private Hospitals Association of Kenya (RUPHA). The report reveals that 9 out of 10 Kenyans are still paying for medical expenses out of pocket, a situation that underscores the urgent need for reform in healthcare financing.

Current Healthcare Financing Landscape

In Kenya, many citizens rely heavily on out-of-pocket payments for medical services. This trend places a substantial financial burden on families, particularly those in low-income communities. The National Hospital Insurance Fund (NHIF) was established to alleviate some of these costs, but issues such as delayed reimbursements and inadequate funding have hindered its effectiveness. RUPHA has reported that at least Sh29 billion is owed to hospitals in historical debts, with an additional Sh6.9 billion frozen within the NHIF.

Challenges for Healthcare Providers

Healthcare facilities across the country are struggling due to these financial constraints. Many hospitals report a lack of essential medications and resources needed to provide adequate care. Dr. Brian Lishenga, chairman of RUPHA, has noted that several facilities are falling behind on rent and salaries, leading to a precarious situation where some hospitals are unable to operate effectively. The expiration of contracts between healthcare providers and NHIF has further complicated matters, leaving many facilities without the necessary agreements to deliver services.

Impact on Patients

The reliance on out-of-pocket expenses has dire consequences for patients. Many individuals are unable to afford necessary treatments, such as renal dialysis or cancer care, which can lead to worsening health conditions or even preventable deaths. The financial strain caused by high medical costs often forces families to make difficult choices about their health care.

Government Response and Reforms

In response to these challenges, RUPHA has called for a two-year phased transition to the Social Health Insurance Fund (SHIF). This transition aims to create a more structured approach to healthcare financing that could ultimately reduce out-of-pocket expenses for patients. However, recent legal challenges have complicated this process. A ruling declared the Social Health Insurance Act unconstitutional, prompting concerns over the speed and execution of reforms.

Recommendations for Improvement

To stabilize the healthcare sector and improve service delivery, several recommendations have been proposed:

• Renewal and Re-negotiation of Contracts: RUPHA advocates for immediate renewal of contracts with NHIF and better reimbursement rates for healthcare providers.
• Release of Funds: It is crucial for state agencies that owe money to NHIF to release these funds promptly so that payments can be made to healthcare providers.
• Abolishment of Private Health Schemes: Redirecting resources from private health schemes back into NHIF could help alleviate financial pressures on the system.

Conclusion

The findings from RUPHA’s report serve as a wake-up call regarding the state of healthcare financing in Kenya. With most Kenyans still paying out of pocket for medical expenses, it is clear that significant changes are needed to ensure equitable access to healthcare services. Stakeholders must work together—government officials, healthcare providers, and civil society—to address these pressing issues and create a more sustainable healthcare system for all Kenyans.