The relationship between the government and healthcare providers has taken another hit after private and faith based hospitals declined to sign the latest Social Health Authority (SHA) reconciliation agreements. The biggest reason for not signing, they say, is unresolved payment disputes and a lack of transparency in the reimbursement process.
The decision marks the latest challenge facing Kenya’s new health financing system, which replaced the National Hospital Insurance Fund (NHIF) with the promise of delivering more efficient, equitable and universal healthcare. Instead, many hospitals say they continue to grapple with delayed payments, unexplained deductions and mounting financial pressure.
At the centre of the dispute are reconciliation agreements presented by the Social Health Authority to healthcare providers. These documents are intended to confirm the amount of money owed and paid to hospitals after claims have been processed. However, many providers say the figures reflected in the agreements do not match the services they have delivered or the claims they submitted.
Hospitals argue that signing the agreements in their current form could be interpreted as accepting payment amounts they believe are inaccurate. They fear doing so may weaken their ability to pursue outstanding balances or challenge deductions whose basis has not been clearly explained.
The refusal has been led by private and faith based healthcare providers, many of whom say they have been operating under increasingly difficult financial conditions. Delayed reimbursements have reportedly affected their ability to pay staff, purchase medicines, settle supplier invoices and maintain essential medical services.
Healthcare providers have maintained that they are not rejecting SHA itself, but are instead calling for greater accountability and transparency in how claims are processed and payments are calculated. They want disputed claims reviewed, outstanding arrears settled and clearer communication on why some reimbursements have been reduced.
The standoff comes at a sensitive time for Kenya’s healthcare reforms. Since SHA became operational, patients across the country have reported challenges ranging from system outages and registration difficulties to uncertainty over covered services. Hospitals have similarly voiced concerns about the pace of reimbursements and the administrative burden associated with the new system.
If the dispute remains unresolved, patients could ultimately bear the greatest burden. Some healthcare facilities may limit services offered under SHA, require patients to make cash payments before treatment or suspend acceptance of SHA for certain procedures until payment issues are addressed.
For now, healthcare providers insist they remain committed to serving patients, but say sustainable healthcare cannot exist without a reimbursement system that is timely, transparent and trusted by both government and providers.
As discussions continue, the outcome of the dispute could have significant implications for the future of Kenya’s universal health coverage ambitions. A healthcare financing system depends not only on enrolling millions of citizens, but also on maintaining the confidence of the hospitals and healthcare workers responsible for delivering care every day.
