Government Forms Committee to Review Social Health Insurance Tariffs and Benefits

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NAIROBI, Kenya Dec 16 – The government is in the process of forming a committee to review tariffs and benefits under the Social Health Insurance Regulations.

According to Medical Services Principal Secretary Harry Kimtai, the committee will be tasked with evaluating the current system and offering practical solutions to address both immediate and long-term challenges.

“Based on feedback from stakeholders gathered over time, the committee will be expected to review and provide practical solutions and make informed recommendations. The Committee report will address both short- and long-term interventions to ensure SHA sustainability and responsiveness to the needs of Kenyans,” the PS noted.

The aim is to ensure the sustainability of the Social Health Authority (SHA) and improve its responsiveness to the healthcare needs of Kenyans.

Kimtai further clarified that the SHA’s coverage is guided by gazetted tariffs, which define the benefits and are designed to ensure both sustainable healthcare coverage and equitable access for all. He also highlighted that if hospital charges exceed the set limits, beneficiaries may be required to make co-payments.

The SHA implementation, which began on October 1, 2024, is progressing with member registration, contracting healthcare providers, and the ongoing digitization of health systems to improve access to healthcare services.

“SHA is proactively addressing emerging challenges to ensure seamless access to all services like cancer management, renal care, maternity, and outpatient care. We are committed to removing any barriers that may hinder access, ensuring beneficiaries face no hurdles in obtaining the care they need,” Kimtai emphasized.

The PS acknowledged the Government’s commitment to advancing Universal Health Coverage (UHC) through the Taifa Care program, a core element of the Bottom-Up Economic Transformation Agenda (BETA).

Kimtai further encouraged Kenyans to enroll in SHA, and informal sector members to undertake means testing and remit their premiums to ensure the continuity of service delivery.

“Employers are encouraged to ensure all their employees are on boarded on SHA and promptly remit their monthly premiums,” he said.

Additionally, the Government is evaluating avenues to bolster the overall healthcare delivery system, including the potential recapitalization of the Kenya Medical Supplies Authority (KEMSA) to improve the flow of essential commodities to healthcare facilities. This measure will complement SHA’s efforts to ensure uninterrupted access to critical healthcare services.

Source: capitalfm