The Social Health Authority (SHA) has confirmed that it will finalize the payment to health facilities for services they provided under the national health insurance system in the next three weeks.
In a statement on Tuesday, July 22, the SHA Chief Executive Officer, Mercy Mwangangi, confirmed that the authority is currently scrutinising all healthcare claims that were made by July 1 by the over 9000 contracted healthcare facilities in the country to ensure that they are in line with the Authority's regulations.
According to Mwangangi, the authority has already completed the review of the primary healthcare fund and the maternity package, and payments were to be made today, July 22.
Furthermore, Mwangangi said that the authority is currently reviewing inpatient, surgical packages, and other medical claims, and payments will be made in the next three weeks.
So far, Ksh3 billion has been disbursed to eligible facilities after the authority finalized the review of claims for accident and emergency, haematology and oncology, and renal care services.
"SHA is currently reviewing all healthcare claims to ensure compliance with contractual obligations and access rules as stipulated under Social Health Insurance Regulations 59 and 61," Mwangagi said.
Delayed Disbursement
The payment announcement comes amid concerns about delayed disbursement, a factor that some facilities claim has crippled their ability to deliver quality healthcare.
A study by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) recently revealed that only 20 per cent of facilities contracted under SHA’s Primary Health Care (PHC) model received full monthly reimbursements.
According to the Ministry of Health, a total of 9,365 facilities, including 5,219 public facilities, 3,650 private hospitals, and 496 faith-based institutions, are currently contracted under the SHA scheme.
“About 36% of the facilities had resorted to debt, 30% were at risk of defaulting on these loans, 13% were at risk of auction, 9% faced small claims court cases from suppliers, and 1% had already shut down operations,” RUPHA said.
In a statement on Tuesday, July 22, the Health Cabinet Secretary Aden Duale revealed that 24 million Kenyans have enrolled with the insurance scheme.
According to Duale, 4.5 million Kenyans have already received treatment for common illnesses and maternal care, while 2.2 million Kenyans have benefited from specialised care.
