NAIROBI, Kenya, Nov 14 – A survey by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) has found that over 55 percent of patients are turning to out-of-pocket (OOP) payments following the rollout of the new Social Health Insurance Funding (SHIF) model.
Approximately 94 percent of surveyed facilities report that many patients choose OOP due to lack of registration with the Social Health Authority (SHA).
The report highlighted that SHA registration challenges, which affect 57 percent of outpatient clients and dependents, are a primary factor pushing patients to OOP payments.
The SHA transition has achieved a below-average success rate of 47 percent, with RUPHA attributing this to ongoing issues with patient verification, portal reliability, and financial burdens on patients and facilities.
Patients in higher-level hospitals are particularly affected, as limited reimbursements for outpatient services and rising costs for ICU, HDU, and ultrasound services prompt a shift to OOP payments.
The report also noted a shortage of covered medications at primary healthcare facilities, forcing SHA-insured patients to pay out-of-pocket for essential drugs.
The SHIF model has faced scrutiny in recent months for its impact on patient costs and access to timely care.
Another recent survey by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) across Nairobi, Kiambu, Meru, and Bomet counties identified similar issues, including access delays, limited private facility coverage, and inadequate specialized care.
