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Kenyans to pay for bills in cash after hospitals halt the provision of some medical services under the NHIF cover

Hospitals halt the provision of some medical services under the NHIF cover over delays by the government to disburse funds.

Beneficiaries of the National Hospital Insurance Fund (NHIF) in rural areas will now be paying for crucial health services.

The action was taken in response to the Rural Private Hospitals Association of Kenya’s (RUPHA) actualization of its threat to stop providing some medical services under the National Health Insurance Program (NHIF) due to the government’s failure to release funding for the previous six months.

RUPHA released a statement claiming that the association and the government had reached a standoff over the government’s inability to fulfill its half of the agreement, leading to the decision.

NHIF beneficiaries are required to pay Ksh. 1000 for treatment at outpatient facilities, which is one of the primary services that is impacted.

Other important services that beneficiaries will pay for  include cancer treatment, where beneficiaries will cover consultation costs, lab test costs, and procedure costs for any interventions, and surgery, where patients will pay for the cost of the operating room. 

In addition, patients on the Linda Mama Scheme will be required to pay a theatre cost for a Caesarean section and a procedural fee for a typical delivery.

RUPHA however notes that members of the Emergency and Critical Situations section will not be affected and that hospital facilities will continue to attend to patients without any changes. 

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“We regret to inform you that due to persistent challenges in receiving payments from the National Hospital Insurance Fund (NHIF), the Rural Private Hospitals Association of Kenya (RUPHA) has been compelled to take certain measures to ensure the continued provision of essential healthcare services,” reads the notice.

“In light of the above, please be advised of the following changes to access to services for WHIP beneficiaries, effective December 20, 2023.”

While regretting the decision which affects the public, the Association has reiterated its previous calls to the government to disburse funds for a seamless delivery of services.

RUPHA Chairman Dr. Brian Lishenga in a letter to NHIF Board Chair Eng. Michael Kamau issued a seven-day notice to the government last month to disburse the funds, arguing that the delay violated the law.

“It has come to our attention that as of 8th December 2023 and for the last 6 months, the Board has failed to make the required payments to health facilities in strict compliance with the provisions of our Agreement,” he stated.

“This non-payment of healthcare providers represents a persistent and clear breach of our agreement with NHIF.”

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