The Social Health Authority (SHA) has explained the tariffs and co-payment structures aimed at ensuring equitable and sustainable access to healthcare services for all Kenyans.
According to Health Principal Secretarty Harry Kimtai, these are part of the ongoing efforts to manage Kenya's healthcare system more effectively under the Bottom-Up Economic Transformation Agenda (BETA), which prioritises Universal Health Coverage (UHC).
Clear structure of tariffs for 2024
In a statement by the PS, SHA’s new tariffs are designed to provide clarity on the costs associated with healthcare services, especially for critical care units such as Intensive Care Units (ICU) and High Dependency Units (HDU).
The aim is to maintain a shared responsibility model for healthcare costs, ensuring that both the government and beneficiaries contribute to service delivery.
The updated tariffs are available on the SHA website and are applicable to all members of the Social Health Insurance Fund (SHIF).
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According to the Ministry of Health, SHA’s coverage is based on gazetted Tariffs to the Benefits, published in November 2024.
These tariffs are set to ensure that healthcare services remain accessible while maintaining the sustainability of the system.
ICU and HDU Services: What you need to know
The revised tariffs specify the costs for admission to ICU and HDU services. These are high-cost areas of healthcare that require careful management.
The cost of accessing these critical care units depends on the level of the facility visited, with each level offering different rates per day.
Level 4 facilities: Sh3,360 per day
Level 5 facilities: Sh3,920 per day
Level 6 facilities: Sh4,480 per day
Each household is allowed up to 180 days per year for access to these services. Members can access services from empanelled and contracted Level 4-6 facilities, the Ministry clarified.
However, if the cost of services exceeds these set limits, beneficiaries may be required to make additional co-payments. This top-up will be necessary to cover any excess charges beyond the defined limit.
The co-payment system: shared responsibility
Under the new system, co-payments are an essential part of ensuring the continued provision of healthcare services.
When the charges for certain medical services exceed the predetermined limits, the patient or their family will be expected to contribute the additional costs. This shared responsibility model is a fundamental part of SHA’s approach to financing healthcare.