Doctors have rejected the government's proposal to introduce time-based restrictions on Insurance claims preauthorisation, stressing that the current state of the country's healthcare system is unfavorable to consider such an option.
This is after Health Cabinet Secretary Aden Duale earlier revealed the Social Health Authority (SHA) and the Digital Health Authority (dha) may start rejecting claims pre-authorized during official working hours, 8am to 5pm.
In a statement on Wednesday, December 17, the Kenya Medical Practitioners, Pharmacists and Dentists' Union (KMPDU) said that Duale is yet to consult stakeholders of the health sector, especially the medical practitioners' union, on the proposal.
According to the union, even though the proposal aims to ensure transparency in SHA, factors including insufficient staffing, delays in remuneration, high intensity of workload, and lack of incentives will make it an unsustainable option.
"Concerns about accountability, conflicts of interest, and the prudent management of public and insurance resources are legitimate and warrant regulatory attention of the NEC," the statement from the union stated.
"The NEC formally objects to the use of fixed clock-time (8:00a.m.- 5:00 p.m.) as a basis for automatic rejection of insurance claims pre-authorized by public sector doctors and considers such an approach as: Operationally unrealistic and administratively arbitrary," it added.
Further, the union noted that workforce shortage in healthcare facilities often leads healthcare practitioners to work in extended hours, emergency call duties, and thus blurs distinctions between 'on duty' and 'off duty' times.
The Union urged the Ministry to ensure that the proposal aligned with labour laws, was consistent with the Collective Bargaining Agreement (CBA), and developed through meaningful consultation with unions from the healthcare sector.
KMPDU was of the opinion that the ministry should seek alternatives, including structured dual-practice frameworks, roster-based or facility-verified authorisation mechanisms, among others.
The latest demands come a day after the health CS announced a crackdown against doctors accused of earning from private clinics during official working hours, insisting that such activities amount to fraud, which is against the country's public health system.
According to Duale, the practice denied public hospitals both patients and revenue, despite the doctors being on government payrolls between 8am and 5pm.
“It has become so rampant that doctors working in Government facilities are opting to send patients to private facilities they are operating in and either denying the facilities that pay them salaries or disregarding them completely,” Duale said.
