Insurance firms accused of manipulating patients' selection of hospitals by doctors

In a recent development, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has compiled a list of complaints from doctors, patients, and hospitals, intending to present them to the Insurance Regulatory Authority (IRA) within two weeks. The complaints centre around insurance companies overstepping their mandate and interfering in healthcare delivery.

Insurance firms are being strongly condemned for dictating where patients should seek treatment, which doctors they should consult, and which tests and drugs should be administered. Doctors claim that these practices have increasingly restricted access to healthcare, with insurers refusing to authorize certain procedures, delaying payments to hospitals, and blacklisting facilities.

The union accused insurance companies of not caring about the outcomes for patients, despite owing hospitals millions. KMPDU believes that insurance is meant to protect patients, not to control healthcare for profit. Dr Atellah, a medical professional, stated that insurance companies prioritize maximizing profits over patients' health.

Many healthcare providers fear exposing the malpractice due to threats of being blacklisted. The union has threatened to take legal action against companies found guilty of malpractice.

The life of a patient in Eldoret could have been saved if insurance restrictions were not in place. A tragic incident at War Memorial Hospital saw a patient die due to delays caused by insurance restrictions. Similarly, a patient in the same county died due to delays caused by insurance-related issues at Nairobi Hospital.

Insurance firms recently suspended services at Nairobi Hospital, alleging a hike in charges for diagnostic and treatment services. However, the hospital claims the move was due to high costs of medical and pharmaceutical commodities.

Apart from Nairobi Hospital, insurance firms are accused of interference in Vihiga, Kiambu, and Trans Nzoia among other counties. Solutions between insurance firms and the hospital management on the matter at Nairobi Hospital are yet to be found.

The union has urged President Ruto to scrap the Strategic Health Alliance (SHA) and revamp the National Health Insurance Fund (NHIF). KMPDU announced it will demand transparency and accountability from insurance companies.

The union warned against dismissal threats as doctors strike in Kiambu. Insurance firms maintain they are not able to cater for the hiked tariffs and have directed their clients to seek care in other hospitals.

In light of these allegations, it is clear that the insurance industry in Kenya needs to reevaluate its practices to ensure they prioritize patient care over profits. The KMPDU's call for transparency and accountability is a step in the right direction towards achieving this goal.

Insurance firms accused of manipulating patients' selection of hospitals by doctors