The Social Health Insurance Act of 2023 was put into effect to establish a comprehensive structure for managing social health insurance in Kenya, aligning with Article 43(1)(a) of the Constitution and the overarching goal of achieving universal health coverage. Enacted on November 22, 2023, the Act brought into existence the Social Health Authority, which is tasked with overseeing various funds and supervising healthcare services.
Key components of the Act entail the formation of the Social Health Authority as a perpetual corporate body. This Authority assumes critical responsibilities, including but not limited to, registering beneficiaries, administering funds, engaging healthcare providers through contracts, and providing guidance to the Cabinet Secretary on health insurance policies.
The functions and powers delegated to the Authority encompass a spectrum of tasks such as managing funds, receiving contributions, accrediting healthcare providers, and formulating operational guidelines for the funds. It holds authority to manage assets, receive donations, and establish beneficial associations.
Governance of the Authority rests in the hands of a Board comprised of diverse representatives, including government officials, healthcare professionals, and sector representatives. These Board members serve a term of three years and may be reappointed.
The Chief Executive Officer (CEO) of the Authority is appointed through a competitive process overseen by the Board and is entrusted with day-to-day management. Qualifications for the CEO include a master’s degree, relevant experience, and adherence to constitutional guidelines.
Protections are afforded to Board members and Authority staff for actions carried out in good faith, while remuneration is determined by the Cabinet Secretary in consultation with the Salaries and Remuneration Commission.
A primary healthcare fund is established to procure essential services from health facilities, financed through appropriations, grants, and donations, with expenditure subject to approval by the Authority and the National Assembly.
The Social Health Insurance Fund is created to extend health insurance coverage to all Kenyan citizens, necessitating registration and contributions from various sources, including households, governments, and employers. Measures are in place to ensure timely contributions and provide premium financing products for non-salaried individuals.
Additionally, the Act outlines the establishment of an Emergency, Chronic, and Critical Illness Fund to cover treatments beyond social health insurance coverage, sourced from appropriations, grants, and donations.
Provisions for essential healthcare benefits, tariffs, empanelment of healthcare providers, claims management, and dispute resolution mechanisms are detailed in the Act to ensure effective operation of the funds.
Furthermore, miscellaneous provisions include stakeholder engagement requirements, digitization of processes, delineation of offenses and corresponding penalties, regulations for the Act’s implementation, and the Act’s superiority over conflicting legislation.
Leave a Reply