Teachers, Police Officers To Start Paying Own Medical Bills As Scheme Faces Financial Challenges

• Hospitals have accused Medical Administrators Kenya Limited (MAKL) of delaying processing KSh 5 billion capitation claims
• In a letter copied to Inspector General of Police Japhet Koome, Nairobi West Hospital has threatened to suspend its services to police officers over KSh 576.79 million bill
• The crisis looms despite the government allocating KSh 17.6 billion to the Teachers Service Commission (TSC) and KSh 13.6 billion to the National Police Service Commission

Amos Khaemba, a journalist at TUKO.co.ke, brings more than three years of experience covering politics and current affairs in Kenya.

Nairobi - Teachers and police officers across the country have found themselves unable to access medical services from health facilities.

Daily Nation reported that policyholders enrolled in the government-funded medical insurance scheme for teachers, police, and prison officers will now start paying medical expenses from their own pockets.

Hospitals responsible for treating teachers and police have threatened to suspend services due to KSh 5 billion in unpaid capitation claims.

Why hospitals are suspending services

The financial challenges for hospitals have persisted despite the government allocating KSh 17.6 billion to the Teachers Service Commission (TSC) and KSh 13.6 billion to the National Police Service Commission.

Hospitals have accused Medical Administrators Kenya Limited (MAKL) of delaying processing capitation claims.

For instance, Nairobi West Hospital, which is owed KSh 576.79 million, has written to MAKL demanding payment for outstanding medical claims, arguing that it has exceeded its credit limit.

"Please note that the above amounts continue to accrue as the medical service provider continues to provide services to your members. In effect, the company has exceeded its credit limit of KSh 200 million.

Please note that failure to fulfil your contractual obligations on payment has led to constraints in the hospital's operations, including not limited to, the inability to pay our doctors, and service providers, thus negatively impacting our procurement of medicine and other consumables," Nairobi West Hospital said in a letter MAKL

Senate launches probe into MAKL

According to the contract, hospitals are expected to give MAKL a seven-day notice before suspending services.

Already, Inspector General of Police Japhet Koome has written to CIC General Insurance Limited over the demands of Nairobi West Hospital’s demand for payment of outstanding claims.

The complexity of the insurance scheme involves Minet Kenya and a consortium of insurance companies led by CIC General Insurance Limited, which contracted MAKL to process capital for hospitals.

The Senate is investigating the legal status of MAKL, which is a private entity at the centre of complaints by policyholders.

NHIF accused of breaching contract

In related news, the Rural Private Hospitals Association of Kenya (RUPHA) accused the National Hospital Insurance Fund (NHIF) Board of Management of failing to fulfil its obligations outlined in the agreement with healthcare providers.

In a statement by the Executive Committee chairman, Brian Lishenga, RUPHA stated that patients would be required to make top-up cash payments to access services from Friday, December 15, due to the failure by NHIF.

"As a result of the Board's failure to honor its financial commitments, health facilities are left with no other recourse but to issue immediate notice that beneficiaries of the NHIF Schemes will be required to make TOP-UP cash payments in order to access services, effective from 15th December 2023," read the letter seen by TUKO.co.ke.