The Government of Kenya, through the newly established Social Health Authority (SHA), has announced updates to healthcare tariffs as part of its push for Universal Health Coverage (UHC). The changes aim to improve access to equitable and affordable healthcare, addressing critical health needs such as ICU admissions and cancer management.
SHA replaces the National Health Insurance Fund (NHIF) under the Social Health Insurance Act, which came into effect on October 1, 2024. The initiative is a cornerstone of the Government’s Bottom-Up Economic Transformation Agenda (BETA), targeting improved healthcare delivery for all Kenyans.
The SHA has introduced new tariffs for Intensive Care Units (ICU) and High Dependency Units (HDU), providing a structured payment plan for beneficiaries. Under the Provider Payment Mechanism (PPM), the daily reimbursement rates for critical care services are set as follows:
- Level 4 Facilities: KES 3,360 per day
- Level 5 Facilities: KES 3,920 per day
- Level 6 Facilities: KES 4,480 per day
Each household is entitled to 180 days of coverage annually for critical care services. However, patients will need to make co-payments for expenses exceeding the stipulated cover limits. The cover applies equally across public, faith-based, and private hospitals.
SHA has responded to concerns regarding the affordability of healthcare services amid rising medical costs. In November 2024, the Ministry of Health published a gazetted list of tariffs for hospital charges to ensure transparency and sustainability of healthcare delivery.
The Ministry emphasized that these tariffs, accessible via the SHA website, aim to maintain shared responsibility between beneficiaries and healthcare providers. The SHA framework ensures hospitals are fairly reimbursed while minimizing out-of-pocket expenses for patients.
The SHA is also tackling long-standing healthcare challenges such as cancer management, renal care, maternity, and outpatient services. By removing administrative hurdles, the authority seeks to provide seamless access to healthcare, ensuring patients face no delays in receiving essential treatments.
To ensure smooth implementation, the Government is urging all Kenyans, including informal sector workers, to enroll in the Social Health Authority (SHA). Mass testing and regular premium remittances are critical steps to maintain healthcare access. Employers have also been encouraged to board their staff to the scheme and ensure timely payments.
The Ministry of Health is also evaluating avenues to strengthen the healthcare supply chain, including the recapitalization of the Kenya Medical Supplies Authority (KEMSA). This move is expected to facilitate the flow of essential medical supplies to healthcare facilities, complementing the SHA’s efforts.
The SHA guarantees healthcare coverage to every Kenyan regardless of economic background. The Public, Private, and Faith-Based Hospitals are required to adhere to the new guidelines, ensuring standardized care across the country. Beneficiaries will be able to access services at contracted Level 4, 5, and 6 facilities.
As the SHA continues to refine its framework, the Government has urged Kenyans to stay informed through official communication channels. For detailed information on tariffs and access rules, beneficiaries can visit the SHA website or contact the SHA helpline at 147.
The rollout of the SHA represents a significant step towards achieving Universal Health Coverage, promising affordable and efficient healthcare services for all Kenyans. With an emphasis on transparency, equitable access, and stakeholder collaboration, the Social Health Authority Kenya is set to redefine the country’s healthcare landscape.
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