The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has accused a section of insurance companies of frustrating access to healthcare in the country.
In a statement on Tuesday, August 19, KMPDU claimed that the insurance firms have positioned themselves between doctors and patients, undermining the delivery of quality healthcare services.
"Insurance cartels are standing between doctors and their patients, denying Kenyans quality healthcare. They dictate which hospitals patients visit, which doctors they see, and which tests and drugs they get.
"They delay claim settlements, force cash payments, make SHA pay bills upfront, drain public funds meant for the poor, and raise premiums while capping provider charges," the statement read.
KMPDU further criticized regulatory bodies for allegedly failing to protect patients, further threatening to publish a list naming those involved.
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"Big insurance companies are blackmailing healthcare providers, and regulators (Competition Authority & Insurance Regulatory Authority) have failed to act. KMPDU will soon release a 'List of Shame' to guide Kenyans on which companies to avoid," the statement added.
This comes days after Health Cabinet Secretary Aden Duale 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.
"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.
