Rural residents covered by the National Hospital Insurance Fund (NHIF) in Kenya are bracing for a challenging situation as the Rural Private Hospitals Association of Kenya (RUPHA) issues a stern warning that could result in cash payments for medical services starting next week.

In a letter addressed to NHIF Board Chair Michael Kamau, RUPHA Chairman Brian Lishenga expressed the association's frustration over the government's failure to disburse funds for the last six months, jeopardizing the provision of crucial medical services.

“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,” Lishenga stated unequivocally.

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

Lishenga outlined the specific services affected, indicating that beneficiaries might soon be required to pay for surgical procedures, outpatient capitation schemes, the Linda Mama scheme, Edu Afya medical scheme, and the suspended e-claims system since 2019.

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“As a result of the Board's failure to honour its financial commitments, health facilities are left with no other recourse but to issue immediate notice that beneficiaries of the NHIF Schemes will be required to make top-up cash payments in order to access services, effective from 15th December 2023,” he warned.

The RUPHA boss emphasized the terms agreed upon with NHIF, pointing out that the Board pledged to disburse Sh1,000 annually per beneficiary within the first 30 days of the capitated period.

Furthermore, timely payments for covered services were assured within an extended period of up to three months.

“Clause 1.3.1 clearly states that the Board undertakes to pay to the Health Facility, for a Beneficiary of the National Scheme, a Capitation amount of Kenya Shillings One Thousand (KES 1,000) per Beneficiary per annum within the first thirty (30) days of the capitated period,” Lishenga highlighted.

“Clause 12.8 specifies that the Board shall make payments to the Health Care Provider for Services covered under the Fund’s various schemes in accordance with the Schedules of this Agreement on a timely basis but in any event, Clean Claims shall be paid within ninety (90) days of receipt of the claim from the Health Care Provider, in strict compliance with the provisions of this Agreement."

As the deadline approaches, the looming possibility of cash payments for essential health services adds a layer of uncertainty for NHIF beneficiaries in rural areas, highlighting the critical need for prompt government intervention to address the funding delays and avert a potential healthcare crisis.