Patients seeking treatment in private hospitals under the Rural and Urban Private Hospitals Association of Kenya (RUPHA) will have to pay cash upfront from January 1, 2025.
This decision follows a prolonged financial crisis caused by the government’s failure to settle debts amounting to Ksh 29 billion, accrued under the now-defunct National Health Insurance Fund (NHIF).
RUPHA has expressed frustration over the government’s lack of commitment to resolving the debt, leaving many hospitals struggling to stay operational.
The situation has worsened under the Social Health Authority’s (SHA) new funding model, which the association argues has reduced healthcare reimbursements, making it difficult to sustain services.
The association’s chairperson, Brian Lishenga, warned that without immediate government action, hospitals would have no choice but to demand cash payments to remain open.
According to him, many facilities are overwhelmed, with a majority defaulting on loans, facing legal disputes, and being unable to pay staff salaries for months.
“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,” Lishenga stated.
RUPHA pointed out that outpatient care, ICU, and HDU services have become unsustainable under SHA tariffs. The rates, which range between Ksh 3,360 and Ksh 4,480 per day depending on the hospital level, often leave patients covering extra costs out of pocket.
Lishenga criticised this as a major departure from the government’s promises, saying Kenyans are now receiving far less coverage despite paying higher contributions.
“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. If the government is collecting more money through contributions, why are these benefits not being reflected in the services?” He said.
At the same time, the Kenya Union of Clinical Officers (KUCO) has accused the SHA board of sidelining clinical officers from key processes, such as contracting and patient authorisation.
In protest, the union announced its members will no longer attend to NHIF patients until their concerns are addressed. They have also called on President William Ruto to overhaul the SHA board and appoint officials who can deliver on the goal of Universal Health Coverage.
