Private hospitals maintain MAKL service suspension despite resuming SHA services

Private hospitals have called off their boycott of Social Health Authority (SHA) services following the government's commitment to clear outstanding arrears owed to healthcare providers under the National Health Insurance Fund (NHIF).

The Rural and Urban Private Hospitals Association (RUPHA) has however maintained that services under Medical Administrator Kenya Limited (MAKL) will remain suspended due to unresolved financial concerns.

In a statement on Thursday, RUPHA acknowledged the directive by President William Ruto to begin settling NHIF arrears and to establish a verification process for larger claims. While the Association noted that this move does not resolve all their concerns, it described it as a crucial first step in addressing the financial challenges faced by healthcare providers.

“After extensive deliberations, we have reached a decision to call off the boycott of SHA services, effective immediately, while closely monitoring the government’s actions to ensure full implementation of its commitments,” RUPHA’s executive committee said.

However, it clarified that the suspension of MAKL services would continue, citing a lack of action from MAKL in addressing concerns raised by healthcare providers.

RUPHA outlined several reasons for lifting the SHA boycott, including the government’s pledge to settle NHIF arrears and the need for fairness in payments to facilities owed more than Sh 10 million.

On Wednesday, President William Ruto ordered the immediate payment of all NHIF claims below Sh10 million, a move that will benefit 88 per cent of affected healthcare providers (2,986 facilities).

Financial stability

Rupha said the payments will allow Level 2, 3, and 4 hospitals to regain financial stability and continue operations.

The Association has requested that hospitals with claims exceeding Sh10 million receive an upfront payment of Sh 10 million while awaiting verification. This, it noted, will ensure large hospitals with clean claims receive immediate relief.

RUPHA stressed that the boycott was a necessary advocacy tool but not a permanent solution.

“Now that the government has demonstrated goodwill, we must engage proactively to ensure full execution of commitments while continuing to advocate for fair treatment of all providers,” read the statement.

It added that the phased payment plan could have created divisions between smaller and larger hospitals. It said the push for an upfront Sh10 million payment for all affected providers aims to maintain solidarity.

Despite the progress on SHA payments, RUPHA said that MAKL had failed to address key concerns raised by its members, leading to the continued suspension of MAKL services.

“The following serious concerns remain unaddressed: no reconciliation of outstanding debt, lack of payment transparency, and unilateral invoice discounts,” the Association said.

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Despite the progress on SHA payments, RUPHA said MAKL had failed to address key concerns raised by its members, leading to the continued suspension of MAKL services.

The Association highlighted issues such as the lack of reconciliation of outstanding debt, lack of payment transparency, and unilateral invoice discounts as the main reasons for maintaining the suspension.

It noted that hospitals are unable to track outstanding payments due to a lack of proper reconciliation, while MAKL is not issuing remittance advice for payments made, leaving hospitals without clarity on amounts paid, deductions or calculations.

Additionally, MAKL is imposing 10-30 per cent discounts on hospital invoices without justification or provider consent.

RUPHA has called on MAKL’s underwriters, Minet and CIC, to urgently address these issues and ensure fair business practices.

Until these concerns are resolved, the Association maintained that the suspension of MAKL services will remain in place.