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The private hospitals association has given the government a two-week ultimatum to pay a staggering KSh76 billion owed for patient claims under the national health insurance scheme, warning that many facilities may shut their doors.
Nairobi, Kenya — 2025-09-06 12:00 EAT.
Private hospitals, under RUPHA, demand KSh76 b in pending payments from SHA and NHIF or will start refusing insured patients.
What happened now: The Rural and Urban Private Hospitals Association (RUPHA) issued a 14-day go-slow notice, warning services to insured patients will stop if KSh76 b in unpaid claims remain unsettled—KSh43 b from SHA and KSh33 b from NHIF.
Why it matters: Hospitals face collapse; millions risk losing access to care.
Status: Developing.
SHA replaced NHIF under the Social Health Insurance Act (2023), operational since October 2024.
Hospitals report claims submitted completed KSh96.2 b by August; SHA has paid only KSh53 b, leaving KSh43 b outstanding. [turn0search6])
The SHA’s current financing model shows a monthly deficit: collecting KSh5.4 b but handling KSh8.7 b in claims.
Constitution/Acts: The Social Health Insurance Act (2023) governs SHA, maintaining hospitals’ right to timely claims processing and due process.
Mandates: SHA must process claims transparently; hospitals assert this has failed.
What’s next: RUPHA demands immediate payment, dispute resolution mechanisms, and transparency on claims status.
RUPHA (Chair Dr. Brian Lishenga): “Hospitals are in crisis… SHA alone is yet to pay KSh43 billion… unless something happens, we are staring at a lot of hospitals shutting down.”
He added: “We demand to know the names of the facilities and publish the amount owed.”
Background: RUPHA accuses SHA of blanket rejection of claims, arbitrary downgrades or suspensions, and failure to provide appeals.
Numbers:
Total outstanding claims: KSh76 b (SHA: KSh43 b; NHIF: KSh33 b).
Submitted claims: KSh96.2 b; paid: KSh53 b.
Payout ratios for general inpatient and surgical claims: 10–20%.
SHA monthly deficit: up to KSh3.5 b.
Documents: Presidential directive (Mar 5, 2025) to clear NHIF arrears under KSh10 m.
Verification: Figures and quotes from Standard, The Star, Tuko, Eastleigh Voice.
Security/Economy: Hospitals may collapse; insured patients could lose access to care.
Governance: SHA’s credibility and financial model undercut; constitutional fairness questioned.
Regional Diplomacy: National healthcare promises falter; impacts on universal health coverage agenda.
Will the government meet RUPHA’s demands within 14 days?
Which hospitals are owed what; full breakdown not public.
Whether SHA will institute a claims clarification portal or tribunal.
What long-term reforms or legislative changes are being considered.
Impacts on rural and low-income communities.
2023-11-22: Social Health Insurance Act enacted.
2024-10-01: SHA operations began.
2025-03-05: Presidential directive to clear NHIF arrears under KSh10 m.
August 2025: Hospitals submitted KSh96.2 b in claims; SHA paid KSh53 b.
2025-09-05: RUPHA issues 14-day notice.
2025-09-06: Crisis unfolds.
SHA or Ministry response within 14 days.
Any partial payments or release of claims data.
Launch of claims portal or dispute tribunal.
Impact on hospitals’ operations and care access.
Broader review of SHA financing and policy.
