KAMWALE: The good and the bad side of SHIF

Since the October 1, 2024, launch of Social Health Insurance (SHI) under the Social Health Authority (SHA), civil servants have expressed concerns about reduced benefits compared to the former NHIF plan.

Under NHIF, civil servants enjoyed broader coverage, higher reimbursement rates, and access to private and faith-based facilities for specialised treatments, minimising out-of-pocket expenses.

However, the new SHA scheme has standardised benefits, reducing some privileges that civil servants previously relied on, such as extensive access to private facilities and certain high-cost treatments.

SHA’s stricter reimbursement limits and fewer partnerships with private providers mean civil servants now have fewer healthcare options and may incur additional costs for treatments that were once fully covered.

Many feel that SHA’s universal model, while beneficial for the general public, has compromised the tailored benefits they previously enjoyed under NHIF.

This perceived reduction in coverage has led to dissatisfaction, with calls for SHA to consider adjustments that better meet the needs of civil servants.

Moreover, mental health coverage has seen some improvements, but limitations remain.

SHA now provides coverage for inpatient mental health services at level six hospitals, while outpatient mental health services are available only at accredited facilities.

Additionally, rehabilitation services are included but are capped at a rebate of Sh67,500, which may not fully cover long-term rehabilitation costs, leaving patients with out-of-pocket expenses.

While this expanded coverage represents progress in mental health support, many feel it falls short of meeting the comprehensive needs of those requiring specialised or extended mental health care.

While there are some disadvantages associated with the Social Health Authority (SHA), such as concerns over limited coverage for civil servants compared to their previous NHIF benefits, there are also several significant advantages.

SHA offers coverage for essential health services that make healthcare more accessible. These include : Dialysis for patients with kidney conditions, ensuring they can receive life-saving treatment without financial strain.

The plan also includes advanced surgeries, such as cardiothoracic procedures, providing access to specialized care that may have been cost-prohibitive in the past.

Additionally, SHA covers chronic condition management, supporting long-term care for patients with conditions like diabetes and hypertension.

These benefits aim to improve overall healthcare access, reduce financial barriers, and ensure that essential treatments are available to a wider segment of the population.