SHA warns hospitals against denying patients emergency care

SHA CEO Mercy Mwangangi says emergency treatment should not be made conditional on a patient's financial circumstances. [File, Standard] 

Hospitals contracted by the Social Health Authority (SHA) risk losing their accreditation if they deny or delay emergency treatment to patients over their inability to pay.

In a notice issued on Saturday, SHA Chief Executive Mercy Mwangangi directed all contracted healthcare providers to comply with their legal and contractual obligation to provide emergency medical care without discrimination, including when a patient's SHA benefits have not yet been confirmed.

The directive comes amid concerns over reports of patients being asked to make upfront payments or provide proof of insurance before receiving urgent medical attention.

Dr Mwangangi said emergency treatment should not be made conditional on a patient's financial circumstances, benefit verification or ability to provide a deposit.

“No patient requiring emergency medical treatment should be denied care, referred or transferred solely on financial grounds,” she said in the notice.

The directive is anchored on Article 43(2) of the Constitution, which guarantees every person the right to emergency medical treatment.

Under the notice, SHA-contracted facilities are required to provide mandatory emergency services and stabilise patients requiring urgent care, even where payment arrangements have not been established.

The Emergency, Critical and Chronic Illness Fund (ECCIF) is meant to finance eligible emergency services for the first 24 hours of treatment.

Thereafter, eligible care is funded through the Social Health Insurance Fund (SHIF) or other applicable payment arrangements.

Mwangangi said facilities that lack the capacity to continue managing a patient should not turn them away. Instead, they must first stabilise the patient before referring them to an appropriate contracted facility.

The authority said such referrals must follow Ministry of Health Referral Guidelines and the terms of the SHA contract.

In the notice, Mwangangi warned that healthcare providers found violating the directive would face contract enforcement measures, including de-empanelment and possible termination of their SHA contracts.

They could also face additional action from relevant regulatory or enforcement agencies.

The CEO further directed hospital Chief Executives, medical superintendents, administrators and emergency department staff to immediately circulate the notice among clinical, admissions and finance teams and ensure full compliance.

The directive comes as patients and families continue to raise concerns about difficulties accessing emergency services while hospitals await confirmation of SHA benefits.

Some healthcare providers have cited reimbursement delays, verification challenges and financial pressures as factors affecting service delivery under the new health insurance system.

However, SHA maintains that such administrative and financial challenges cannot override a patient's constitutional right to emergency treatment.

The notice therefore places a clear obligation on contracted facilities to prioritise stabilisation and treatment of emergency patients, with payment and insurance verification issues handled within the applicable SHA financing and contractual arrangements.

For patients, the directive reinforces that emergency care should not be withheld because they cannot immediately make a payment or because their SHA coverage is yet to be verified.