The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has threatened to expose insurance companies who are working with cartels to undermine patient care.
In a statement on Tuesday, August 19, the KMPDU alleged insurance cartels were acting as gatekeepers between doctors and their patients, consequently compromising the quality of healthcare received by Kenyans.
The KMPDU also accused insurers of dictating which hospitals patients can access, the doctors they are allowed to see, and which tests or medications they are permitted to receive regardless of the medical situation.
This, according to the doctors, heavily restricted medical professionals while also crippling public health resources.
"Insurance cartels are standing between doctors and their patients, denying Kenyans quality healthcare," a statement from KMPDU read.
Among the key accusations tabled by the union was the persistent delay in claim settlements by insurers, which forces patients to resort to paying cash.
In some cases, healthcare providers under the Social Health Authority (SHA) were allegedly being made to pay bills upfront, undermining the intention of Universal Health Coverage (UHC).
The KMPDU also flagged a worrying trend where insurance companies allegedly raised premiums for patients while capping the fees that healthcare providers can charge. This results in reduced access to quality treatment and overworked doctors working in already struggling hospitals.
In its warning, the KMPDU accused regulators including the Competition Authority of Kenya and the Insurance Regulatory Authority, of failing in their mandate to oversee and correct these issues.
“Big insurance companies are blackmailing healthcare providers, and regulators have failed to act,” the union added.
Amid the concerns, the union vowed to release what it is terming a "List of Shame" in an effort to guide Kenyans make informed decisions about which companies to avoid when seeking health coverage.
Since the rollout of SHA, there has been a rampant abuse of the healthcare sector, with the health portfolio being marred by complaints from stakeholders, including patients.
One decisive measure taken by the CS to curb fraud was the suspension of over 40 health facilities from the SHA programme for allegedly engaging in fraudulent activities.
During a presser on August 8, Health CS Aden Duale was adamant the facilities would only be allowed back after they complied with all SHA regulations.
