Some private hospitals have introduced cash charges for services fully covered by the National Health Insurance Fund claiming the insurer has failed to pay them since June.
These are facilities affiliated to the Rural Private Hospitals Association of Kenya (RUPHA), a sector lobby for 400 hospitals.
The decision comes after the lapse of a seven-day notice the lobby had issued on December 8.
At that time, it said NHIF owes its members more than Sh15 billion.
Dr Brian Lishenga, the lobby chairman, said NHIF has failed to pay or underpaid for services rendered over the last eight months, with payouts for medical and surgical admissions ranging from five-10 per cent of valid claims.
“Contractual quarterly capitation payments for outpatient services have not been remitted for the October-December quarter, and the Linda Mama scheme has not made payments since June 2023,” he said at a press conference in Nairobi.
NHIF did not immediately respond to the Star’s query regarding the latest impasse.
Lishenga said preauthorisation for cancer care has either not been approved or reimbursements drastically reduced.
“As a result, many healthcare facilities are on the brink of closure, unable to guarantee crucial services such as outpatient, maternity, surgical, dialysis, and cancer care to NHIF beneficiaries. Employees face up to three months of salary arrears, and essential expenses like rent, utilities, and statutory deductions are in jeopardy,” he said.
The lobby held a special general meeting on Tuesday and decided that NHIF patients will pay Sh1,000 to access outpatient services while those requiring admission will pay an admission fee.
Patients requiring surgery will pay a theatre fee while those receiving cancer care will pay a consultation fee, laboratory testing fees, and procedure fees for any interventions, the lobby said.
It added that for delivery, mothers will pay a “procedure fee” for normal delivery and a theatre fee for caesarean section.
“These resolutions will remain in effect until NHIF regularises payments owed to healthcare facilities during its transition to the Social Health Authority,” they said.
“RUPHA opposes NHIF's transition to SHA without settling its liabilities with providers, and healthcare providers will not be party to a contentious transition.”
This is not the first time rural health facilities have expressed dissatisfaction with the delayed payments from the national health insurer.
In April, they issued a warning, indicating their intention to initiate charges for beneficiaries of programmes such as Linda Mama, Edu Afya, and police officers who depend on their services.
They decried the failure of some insurers to remit funds on time and threatened to transfer bills to patients at a cost of Sh1,000 per visit.
Days after, faith-based health institutions also gave the NHIF and the CIC insurance consortium an ultimatum to release Sh2 billion in claims accrued over time.
Normalcy resumed in various hospitals across the country after the National Treasury released the funds the government owed NHIF in June.
