According to a survey conducted by the Rural & Urban Private Hospitals Association of Kenya (RUPHA), more than half of the Social Health Authority (SHA)-contracted health facilities did not get payment for claims submitted in the fourth quarter of 2024.
The survey, which was conducted between December 24 and December 31, 2024, reveals substantial delays and irregularities in SHA reimbursements, putting many hospitals in financial difficulties.
According to the survey, only 42% of facilities reported obtaining reimbursement for their claims, with 58% receiving none.
Furthermore, just 6% of establishments obtained payments totaling more than 80% of their claims.
In contrast, 30% of the studied facilities received less than 10% of their submitted claims, while 22% received payments for only 10-20% of their claims.
“These delays are crippling healthcare facilities across the country,” stated Dr. Lishenga of RUPHA. “Hospitals are struggling to keep their doors open.”
Nearly 96% of the institutions polled indicated serious financial difficulties, with private hospitals being the hardest hit.89% of facilities cannot meet operational costs.
87% are unable to pay their staff.81% struggle to pay suppliers.
These difficulties have resulted in shortages of critical supplies and an increased reliance on borrowing to keep operations running.
In addition to SHA claims, hospitals cited inequalities in the National Hospital Insurance Fund’s (NHIF) payment of late arrears.49% of facilities reported receiving no NHIF payments.
40% received payments.11% were uncertain if the payments were for arrears.Monthly trends showed limited improvement.
In October 2024, just 19% of facilities were paid, rising to 23% in November before falling to 20% on December 24, 2024.
“The disbursement process needs urgent reforms to ensure timely and equitable payments,” Dr. Lishenga emphasized.
RUPHA has urged the implementation of equitable payment methods and efficient reconciliation processes to address the financial challenges faced by healthcare providers.
The body also asked government entities to prioritize timely disbursements to maintain the long-term viability of health-care services throughout the country.
“A functional healthcare financing system is essential to deliver quality care to all Kenyans,” Dr. Lishenga concluded.
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