State pleads with hospitals to join SHIF as pressure to deliver increases
By Maureen Kinyanjui |
Robert Ingasira, the Acting Chief Executive Officer of the Social Health Authority (SHA) on Friday stated that the government emphasised the need for hospitals to join the initiative.
The government has called on KEPH Level 4 hospitals to participate in the Social Health Insurance Fund (SHIF) to enhance access to affordable healthcare under the Universal Health Coverage (UHC) programme.
This appeal follows the enactment of the Social Health Insurance Act (SHI Act) of 2023, which is designed to transform healthcare delivery in Kenya.
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Robert Ingasira, the Acting Chief Executive Officer of the Social Health Authority (SHA) on Friday stated that the government emphasised the need for hospitals to join the initiative.
"We encourage all KEPH Level 4 (Kenya Essential Package for Health) facilities to take this opportunity to provide Primary Health Care (PHC) outpatient services under the PHC Fund. This is a chance to improve health outcomes for millions of Kenyans," he said.
The SHI Act, which became effective on November 22, 2023, introduced three funds under SHA: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic, and Critical Illness Fund.
The PHC Fund, financed by the National Assembly, primarily targets the provision of services in Level 2 and Level 3 facilities. However, the SHA has now extended this opportunity to selected Level 4 facilities.
"Expanding PHC outpatient services to Level 4 facilities will increase community access to quality healthcare and decongest smaller facilities. This move is a crucial step toward achieving our UHC goals," Ingasira explained.
Under the initiative, participating facilities will be paid on a capitation model, where they receive a fixed amount per enrolled patient based on approved tariffs. The payments will adhere to SHA's standard reimbursement timelines.
The government has assured hospitals that all registered SHA members are eligible for services under the PHC Fund. Vulnerable groups, including pregnant women, children, the elderly, and those under government subsidies, will also be covered.
"No patient should be denied care due to unpaid contributions or membership status, provided they are registered with SHA," Ingasira noted.
The SHA urged hospitals to confirm their participation in writing and align their services with gazetted outpatient care standards.
Contracts for participating facilities will be amended to reflect the additional services.
"The success of UHC depends on the commitment of healthcare providers. This partnership will ensure that Kenyans have access to high-quality outpatient care close to their homes," Ingasira concluded.
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