Kenya to spend Sh5bn (30 billion USD) on health benefits platform
Source：Business Daily
From：Taiwan Trade Center, Nairobi
Update Time：2024/02/14
The Kenya government plans to spend Sh5 billion (30 billion USD) on setting up a single digital platform for lodging, validating and paying medical insurance claims under the social health plan that will compulsorily collect billions of shillings from Kenyans every month.
The Ministry of Health (MoH) discloses in the regulatory impact on the draft Social Health Insurance (General) Regulations, 2023 that it will set up a Centralised Healthcare Provider Management System (CHPMS) to manage claims and help cut fraud.
The system will be used by hospitals to lodge claims when patients go for treatment. It will also review claims, validate them and process payments under the State's ambitious healthcare plan that will be funded by Kenyans to the tune of Sh133 billion per year through a deduction of 2.75 percent of their monthly income.
“The proposed regulations for the establishment of a centralised digital platform that is accessible to the empanelled and contracted health care providers for purposes of claims administration, recording beneficiary data, inputting health care service delivery data, and maintaining health care providers data,” says MoH.
“The system will permit user rights to authorised persons and apply to the board for rights and access to the system in line with the Data Protection Act 2019 and the Digital Health Act, 2023.”
CHPMS will include all beneficiaries’ data as well as data about hospitals and services they provide as Kenya moves to stem cases of fraud in medical insurance. There is also a provision for the system to maintain an audit trail of all processes and have the capability of data retrieval.
MoH estimates that the installation of the system will cut losses linked to fraud to between 10 percent and 20 percent of the total claims paid out. Global estimates indicate that errors and fraud account for between three percent and 15 percent of claim costs.
Source: https://www.businessdailyafrica.com/bd/economy/state-to-spend-sh5bn-on-health-benefits-platform--4500936