Private hospitals issue 14-day go-slow notice over KSh76 b unpaid claims

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.

The Latest

• 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.

Context in Brief

• 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.

Law, Policy, and Process

• 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.

Voices and Stakeholders

• 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.

Evidence & Data

• 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.

Risks and Implications

• 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.

What We Don’t Know Yet

• 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.

Timeline

• 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.

What to Watch

• 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.