The Ministry of Health (MOH) has announced plans to expedite the review of the Social Health Authority (SHA) benefits package, following widespread complaints from Kenyans, particularly those seeking treatment abroad.
“The initial plan was to review the tariff and benefits after two years. However, due to the numerous concerns raised by Kenyans about their experience with SHA, this will be done much sooner,” stated MOH Director General Patrick Amoth during a press briefing on Wednesday.
He also confirmed that measures are being put in place to activate the benefits package tariffs advisory panel, as mandated by law.
A key area of focus is the overseas treatment cap, which is currently set at Ksh500,000. This amount is under review to ensure the scheme achieves its primary goal of providing equitable healthcare coverage.
“SHA supports foreign treatment within the set tariffs, covering up to Ksh500,000,” added SHA CEO Robert Ingasira.
Concerns Over Treatment Costs Abroad
The current cap has raised concerns since the specialized care required for overseas treatment often exceeds Ksh500,000. For instance, procedures like open-heart surgery, stem cell transplants, bone marrow transplants, liver transplants, and arterial switch operations typically cost around Ksh1.5 million. This means SHA only covers about a third of the treatment costs, placing a significant financial burden on patients.
Kenya has seen a sharp increase in the number of patients seeking medical care abroad. Between 2021 and 2022 alone, approximately 569,000 Kenyans were referred for treatment overseas, with India accounting for 80% of these referrals. The high costs are attributed to the complex, high-risk nature of the procedures.
Uniform Benefits for All
Addressing claims that civil servants receive a superior benefits package compared to ordinary Kenyans, Ingasira clarified that the benefits for civil servants were inherited from the National Health Insurance Fund (NHIF) and are now aligned with SHA's offerings.
“We operate a separate scheme for civil servants, but the benefits I mentioned are accessible to all Kenyans registered under SHA. The benefits are uniform,” he emphasized.
This fast-tracked review aims to address public concerns and ensure that SHA provides adequate financial protection for all Kenyans, particularly those facing the challenge of costly overseas treatment.