The Rural Private Hospitals Association of Kenya executive committee chairman Brian Lishenga has said National Hospital Insurance Fund beneficiaries in rural areas will now be forced to pay cash when they visit their member hospitals.
Lishenga said this is because NHIF failed to fulfil its financial obligations outlined in the agreement with healthcare providers.
"As a result of the board's failure to honour its financial commitments, health facilities under RUPHA will now require patients that are beneficiaries of the NHIF Capitated Schemes to pay in cash to access services," he said.
Lishenga said the new directive will commence on May 31.
"We regret having to take this step, but it is necessary to ensure the continued provision of quality healthcare services to our patients," he said.
He said NHIF particularly breached clauses 1.3.1 and 1.3.2 of Schedule 1, pertaining to capitation payments.
Clause 1.3.1 states that "The Board undertakes to pay to the health facility for a Beneficiary of the National Scheme, a capitation amount of Sh1,000 per beneficiary per annum within the first 30 days of the capitated period."
Clause 1.3.2 specifies that "The Board undertakes to pay to the health facility, for a beneficiary of the Managed Schemes without limits, a Capitation amount of Sh2,850 per beneficiary per annum within the first 30 days of the capitated period."
Lishenga said RUPHA has noted that for the April-June 2023 quarter, NHIF has failed to make the required payments to health facilities as of May 29.
"This non-payment represents a clear breach of our agreement," he said.
Lishenga said that despite receiving several letters and assurances from the NHIF since April indicating that the payments would be made, they have yet to receive any remittance.
Lishenga called for immediate action to rectify the breach of the agreement.
He said the outstanding capitation amounts for the April-June 2023 quarter should be paid to RUPHA member health facilities within the next seven business days.
"Failure to do so may force us to explore further actions to protect the interests of our patients and our facilities," he said.
