Patients seeking medical attention at facilities under the Rural and Urban Private Hospitals Association of Kenya (RUPHA) will be required to pay cash for services beginning January 1st.

This decision comes after private hospitals accused the government of failing to address the payment of approximately 29 billion shillings owed to them by the now-defunct National Health Insurance Fund (NHIF).

The hospitals also expressed concerns over reduced capitation amounts under the Social Health Authority (SHA), which they claim has left them struggling to cover operational costs.

The SHA’s healthcare funding model has come under increasing scrutiny, with mounting concerns about its impact on both the cost and accessibility of healthcare.

RUPHA has accused the government of being non-committal in resolving the outstanding debt and has threatened to demand cash payments for services if the issue is not addressed within 14 days.

RUPHA’s chairperson, Brian Lishenga, emphasized the gravity of the situation, stating, "Unless there is substantial movement to settle the NHIF liabilities by January 1st, we will be forced to demand out-of-pocket payments.

We have no other way to keep the facilities open. You cannot have 67% of hospitals defaulting on overdrafts, 25% of hospitals in small claims courts, and three-quarters of hospitals unable to pay their workers for three months and expect healthcare to function normally."

The financial burden on both patients and medical facilities has intensified since the introduction of the SHA, according to RUPHA. The association has pointed to limited reimbursements for outpatient services and increasing costs for ICU and HDU care.

"How is it possible to provide X-rays, ultrasound, and lab tests for just 75 shillings per month per Kenyan? This is not the promise we gave to Kenyans," said Lishenga, highlighting the discrepancy between government expectations and the realities of healthcare delivery.

A recent circular from the Ministry of Health confirmed that SHA's coverage for ICU and HDU patients is based on tariffs gazetted in November 2024.

The rates are 3,360 shillings per day for level 4 facilities, 3,920 shillings per day for level 5 facilities, and 4,480 shillings per day for level 6 facilities, with patients required to cover any excess costs. Lishenga described this as a mismatch with the initial government promise, warning that many Kenyans, despite increased contributions, will face out-of-pocket expenses.

"We were told that if a patient is admitted to ICU, they would be covered for 45,000 shillings for 14 days. Today, we have Kenyans who are reimbursed for only 10% of an ICU bill," Lishenga added. "If the government is collecting more money through contributions, why are these benefits not being reflected in the services?"

Meanwhile, the Kenya Union of Clinical Officers (KUCO) has raised concerns over their exclusion from the SHA empanelment process.

The union accused the SHA board of deliberately omitting clinical officers and their facilities from contracting and pre-authorization procedures under the scheme.

In response, KUCO has announced that clinical officers will not attend to patients registered under NHIF until their grievances are addressed.

The union has also called on President William Ruto to disband the current SHA Board and reconstitute it with individuals who understand the mission of Universal Health Coverage (UHC).