Over 360 rural hospitals plan to charge patients fixed rates for services rendered amid delayed disbursements from the government, which has seen some resort to layoffs to stay afloat.
The Rural Private Hospitals Association of Kenya (Rupha) says the amount received from the National Health Insurance Fund (NHIF) from January is less than a third of the claims they had submitted.
Similarly, the National Police Service (NPS), the Kenya Prisons Service (KPS) and the Teacher Service Commission (TSC) are yet to service claims from the facilities, sinking them further into debt.
“The only option for us is to co-pay so our staff can receive a salary and our facilities can remain open,” said Rupha chairman Brian Lishenga.
A co-pay, short for co-payment, is a fixed amount that a healthcare beneficiary pays for covered medical services, with the balance covered by the person’s insurer.
Administration of the teachers and police schemes is handled by Minet Kenya Insurance Brokers and Medical Administrators Kenya Limited (MAKL)
Already, MAKL has written to medical service providers saying they are experiencing delays in the settlement of payments and that they regret the inconvenience caused.
“Considering the above and as we anticipate payments receipt from our mutual client, MAKL commits to make the payments of the outstanding sign-off amount as soon as we receive the funds,” read the April 18, 2023 letter from MAKL Rupha represents 367 healthcare centres in rural and urban underserved populations such as Kangemi, Kayole in Nairobi and Kisauni in Mombasa.
The contract with the NHIF stipulates that claims will be paid within 90 days, while that with the police and teachers demand that settlements are done within 45 days.
However, this has not been the case with current arrears running as far back as September 2022 in what threatens to cripple operations of the healthcare service providers.