Health Cabinet Secretary Aden Duale has announced the formation of a joint taskforce between the government and private medical insurers to address malpractice in the health insurance sector.
In a statement after a meeting with CEOs of insurance companies on Monday, August 18, Duale said the collaboration also seeks to expand access to affordable and quality healthcare for Kenyans.
"Hosted Chief Executive Officers of Medical Insurance Companies at Afya House, Nairobi, for a strategic engagement on bridging the financial gap in healthcare.
"We agreed to establish a Joint Anti-Fraud Action to crack down on malpractice in the sector and strengthen collaboration with the Social Health Authority (SHA) to expand access to affordable, quality healthcare for all Kenyans," he said.
Duale further revealed that the insurance executives were briefed on ongoing reforms under the country’s new health laws.
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"I updated the CEOs on the ongoing Taifa Care reforms anchored in the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act and the forthcoming Quality of Care and Patient Safety Bill, all critical pillars in advancing Universal Health Coverage (UHC)," he added.
According to Duale, among the resolutions reached was the alignment of private insurance packages with SHA’s coverage to enhance service delivery.
"Key resolutions included, Complementary coverage: Private insurers to extend benefits beyond SHA's package and co-finance chronic care; Shared claims & data: Linking insurers to SHA's digital claims platform for transparency and efficiency; Aligned standards: Harmonized accreditation to ensure uniform quality of care," he noted.
In the end, the insurers promised to strengthen the National Health Registry and establishing a regulatory framework for drug pricing.
On his part, Duale reiterated the government's commitment to tackling challenges within the sector, and called for a collaborative framework involving SHA, private insurers and the Insurance Regulatory Authority (IRA).
"The CEOs urged support in strengthening the National Health Registry and establishing a regulatory framework for drug pricing.
"I reaffirmed the Ministry's commitment to tackling structural challenges through legal, institutional and data-driven reforms and called for a Public–Private Collaborative framework involving MoH, SHA, private insurers and IRA," he concluded.
This comes a day after Duale announced a new framework aimed at streamlining the process of sending Kenyans abroad for specialized medical care.
In an update on Sunday, August 17, he revealed that SHA is implementing a new system designed to enhance coordination among all stakeholders involved in the Overseas Treatment Benefit Package.
"The Social Health Authority (SHA) Overseas Treatment Benefit Package under the Social Health Insurance Act, allows for treatment outside Kenya at a set annual rate of Ksh500,000 for services not available locally.
"SHA is aligning with the law, has started contracting, and is implementing a new system to improve coordination among all stakeholders,” he said.
To ensure accountability and high standards of care, foreign hospitals must be formally contracted by SHA, hold accreditation in their home country with recognition in Kenya.
Additionally, the facilities must demonstrate linkages to a local empanelled and contracted facility through a Memorandum of Understanding (MoU).
