William Ruto's Govt Scraps Unlimited SHA Reimbursements for Hospitals, Removes 3m Ghost Patients
- Health Cabinet Secretary (CS) Aden Duale announced a new policy change affecting the Social Health Authority (SHA)
- The Cabinet secretary explained what hospitals should do if they want to treat more patients under the SHA system
- Duale revealed alarming fraud rates across public, private, and faith-based hospitals across the country, noting that they would not be tolerated
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As part of changes aimed at curbing fraud and patient overcrowding, the Social Health Authority (SHA) will no longer give hospitals unlimited reimbursements; instead, payments will be limited to the number of permitted beds.
Source: Twitter
During a two-day retreat of the National Assembly Health Committee in Mombasa, Health Cabinet Secretary (CS) Aden Duale announced a policy change, stating that hospitals can no longer pack patients into a single bed while demanding full payment.
"Many hospitals allow up to four patients to share a bed but still charge SHA for the full number of patients," Duale told the Council of Governors, Members of Parliament (MPs) and health stakeholders on Wednesday, July 9.
"We will restore the dignity of public hospitals because we value the dignity of our patients," he reiterated, as reported by Citizen TV.
How will SHA reimburse hospitals?
Hospitals that wish to treat more patients under the new system must first increase their infrastructure and acquire extra beds.
The health facilities will face repercussions for sharing beds since it will be deemed insurance fraud.
Duale described instances of hospitals systematically over-admitting patients and creating situations where strangers are forced to share beds or sleep on the floor while the medical facilities claim maximum payments.
"Increase the number of beds in your hospital if you wish to admit more patients," he affirmed, as quoted by Daily Nation.
He declared that as long as he is in charge of the ministry, such actions will not be tolerated.
Source: Twitter
How many ghost SHA patients were removed?
Duale described the policy change as a milestone in the reforms under the SHA and Taifa Care reforms.
The government revealed that at least three million fake patients have been removed from the nation's healthcare system.
He revealed alarming fraud rates across public, private, and faith-based hospitals.
"The scam is alarming, with some outpatient cases mistakenly reclassified as inpatient," he stated.
He disclosed that SHA investigations have uncovered cases where a single patient is registered in multiple hospitals on the same day.
"Compared to Kenyatta National Hospital, several private hospitals claim that they perform more surgeries. The statistics are shocking," he added.
How much does SHA pay for ICU patients?
In related news, the specific amounts that the Social Health Insurance Fund (SHIF) covers for patients' daily care under the SHA system have been made public by the Ministry of Health.
ICU treatment for level 4, 5, and 6 hospitals is covered by SHIF to varying degrees under SHA.
With a household limit of 180 days per year, patients can get services from Level 4-6 empanelled facilities. Any charges that exceed the cover limit must be topped up.
Proofreading by Asher Omondi, copy editor at TUKO.co.ke.
Source: TUKO.co.ke
