A crisis is brewing in Kenya’s top National Referral Hospitals as Chief Executive Officers (CEOs) warn that the Social Health Authority (SHA), is underfunding key medical procedures, causing facilities to run services at a loss.
CEOs from the hospitals held a closed-door meeting at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Saturday, where they drafted a joint petition demanding urgent revision of reimbursement rates and expansion of services covered under the new health insurance scheme.
The delegation was led by Kenyatta National Hospital Acting CEO, Dr. Richard Lesiyampe, who said public hospitals were already struggling to stay afloat under the new health financing model.
“SHA must work for us to survive. We have no way out,” he warned. “If the system remains as it is, hospitals will not be able to sustain services. We have raised several concerns that require immediate action,” he added.
At the centre of the standoff is the widening gap between SHA reimbursements and the actual cost of treatment, particularly surgeries requiring specialized implants.
The CEOs said they were being forced to cover the difference, pushing facilities deeper into financial strain.
They revealed that several common surgical procedures, were not listed in the SHA payment schedules, yet hospitals offer them daily.
Without a billing pathway, the services, they said, were being provided at a loss, and if this trend continues, hospitals could eventually become incapable of offering essential services.
Also fueling frustration are millions of shillings in arrears owed to facilities by both the defunct NHIF and its successor SHA.
Hospitals want all pending dues settled and a clear policy for resolving rejected claims, which they say disrupt cash flow and delay procurement of critical supplies.
The CEOs also proposed changes to services covered under the scheme.
They are asking the Authority to increase dialysis sessions from two to three per patient weekly, enhance coverage for kidney transplant patients, and restructure maternal and neonatal service payments for better reimbursement.
The petition further demands the removal of rules that only pay for certain procedures if performed outside the country, despite the same services now being available locally.
To push the negotiations, the CEOs formed a technical committee comprising of surgeons and SHA officials, to address contentious issues and align the Authority’s policies with hospital realities.
Their warning comes after SHA replaced NHIF as Kenya’s primary health insurer, promising universal access to care.
But referral hospitals warn that without urgent amendments, the promise may collapse under financial pressure.
By Chris Mahandara
