Pain for patients as SHIF roll-out crisis deepens
Patients are grappling with a compounded healthcare crisis as the rollout of the new Social Health Insurance Fund (SHIF) continues to faces major hurdles.
A growing number of service providers, including dialysis centres, and private hospitals threatened not to on-board the new system, citing unpaid debts and unresolved issues from the defunct National Health Insurance Fund (NHIF).
The transition to the Social Health Authority (SHA) was intended to streamline healthcare services, but the reality on the ground tells a different story.
With NHIF owing dialysis service providers more than Sh10 billion, many hospitals are refusing to join SHA until their outstanding payments are settled.
This delay is already affecting the availability of essential services, leaving patients stranded and unable to access critical treatments, with kidney and cancer patients being the recent most affected group.
Already, dialysis providers have indicated that they will only transition to SHA after their outstanding payments of Sh10 billion are settled.
The providers indicated that after providing services to kidney patients across the country, the NHIF, which has since ceased working, has failed to reimburse their dues.
Additionally, they have said that the current rates being proposed by SHA do not align with market conditions, leaving many service providers drowning in debt.
Frustrated by NHIF’s inability to fully remit claims, dialysis providers are now refusing to transition to the new system.
“We have worked closely with NHIF for over two decades to provide quality health care for patients with kidney disease, however, we are deeply concerned by the NHIF’s failure to readjust the reimbursement rate to match the market condition and to fully remit claims,” says Dr Jonathan Wala, chairman, Kenya Renan Association.
Read: When the bell tolls at midnight: Mandatory SHIF deductions at your next hospital visit
He adds: “This financial shortfall has forced several dialysis units to shut down, undoing much of the progress made. The now-defunct NHIF owes dialysis providers more than Sh10 billion with no formal mechanism in place to address the crippling debt.”
With the rollout of SHIF, the association indicated that they had hoped for improvement in service delivery and the establishment of a clear and transparent framework for reimbursement but this is not forthcoming.
“We have submitted several recommendations to SHA to address critical gaps in kidney health services but nothing is forthcoming, instead we have since witnessed a chaotic roll with patients being turned away from hospitals,” he said.
“Our patients are currently facing life-threatening uncertainty due to the disorganized SHA rollout, many making out-of-pocket payments, missing sessions, non-citizens not allowed to register with new patients unable to access treatment,”
He said providers have not signed a formal contract with SHA as dictated by the regulations: “The promised digital contract system is yet to be implemented, leaving providers uncertain about their legal standing.”
The association has, therefore, called upon the government to come up with a formal contract with the service providers without delay. Also, the provision of clear and consistent guidelines for patients and providers to ensure uninterrupted service delivery.
“SHA must implement our previous recommendation to improve kidney health coverage in the country including extending dialysis cover to three sessions and expanding transplant services,” says the statement.
The problem with dialysis is not just the interruption of services but even if the services were in place, the sessions have been reduced and the allocation reduced from Sh9,500 to Sh2,375, according to the new proposal benefits.
Hospitals are now sending messages to patients on clinic days to come up with an additional sum of Sh7,000 in cash to top up for their dialysis sessions.
Dialysis is a life-saving procedure, and without timely treatment, many patients could suffer serious health complications or even death.
Read more HERE
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