Mogotio MP Reuben Kiborek on his part said though he cannot complain about referral systems, the spirit of SHA was to stop fundraising, and pleased with the Ministry of Health and SHA leadership to enhance the package capped at Sh500,000.
"To avoid going back to problems we had with NHIF, we need to improve on grey areas," said Kiborek who further said proper communication needs to be done on benefit tariffs to boost enrolment and healthcare.
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Nandi Woman Representative Cynthia Muge pleaded with SHA to negotiate with hospitals that offer overseas treatment to avoid quotation on charges.
In response to overseas treatment, the PS distanced himself from negotiation saying such can only be done by doctors, hospitals and families of patients seeking care.
Kimtai explained that the Kenya Medical Practitioners and Dentists Council (KMPDC) is the entity recognized by law to recommend for empanelment of overseas treatment and that SHA only goes to contracting.
"Approval of oversees treatment is based on the preference of the doctor and where treatment will be done and gives recommendations to KMPDC. SHA only issues a guarantee of payment to that facility.
"We shall only give Sh500,000 we do not come in for negotiations because it is between the patient and the doctor and facility. It should be based on a referral system," Kimtai informed the committee.
Pukose added that the lack of proper referral structure and the problem incurred is giving SHA a "bad image".
On the capped overseas allocation, Seme MP James Nyikal said SHA should rethink what the Sh500,000 can offer, further noting the need for a proper referral system.
Nyikal observed that some referrals are done by doctors who are 'tired' of providing care
An issue of patients seeking chronic and critical illness services in Kenya's public hospitals being forced to pay out of pocket due to the ongoing government financial crisis was also raised during the probe.
The SHA funding shortfall was said to disrupt the financing of healthcare services across level two to level six hospitals.
Kimtai informed the National Assembly Health Committee that SHIF is only partially operational and currently covers emergency services for the first 24 hours after admission.
"At the moment, the fund provides coverage for urgent care, resuscitation, and stabilisation for specific emergency services as outlined in the Gazetted benefit package," Kimtai explained to the committee.
Kimtai added that the services are free for the initial 24 hours, as the fund is Exchequer-funded.
However, he says that due to financial constraints in the current fiscal year, the chronic and clinical illness components of the fund have not been activated.
Amid decry by Kenyans in need of care, Kimtai informed the committee that the emergency, chronic, and critical illness package was only partially operationalized in December, covering emergency services exclusively in level five and level six hospitals.
The financial crisis has therefore left many patients who suffer chronic diseases unable to access the health package, resulting in numerous individuals being turned away from hospitals due to confusion over SHIF's implementation and budgetary constraints.
"The implementation did not take effect immediately after the rollout on October 1, 2024.
The system for these specific services was activated in December, starting with level five and six hospitals. As a result, claims only began coming in at the end of December," SHA director for benefits and claims management Dr Tracy John said.
Additionally, Anthony Lenaiyara, CEO of the Digital Health Agency, confirmed that by last month, 21.6 million claims had been submitted under the fund, which was allocated Sh2 billion in the current financial year's budget, including cases such as cardiac and pulmonary arrest, and major trauma.
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Nevertheless, the benefit tariff on dental and optic care was also raised by the Pukose committee as an issue of concern among Kenyans.
Nyeri MP said in the benefit tariffs, SHA is encouraging the extraction of teeth which is criminal according to the World Health Organisation.
Muge raised an issue with the allocation for optical and oral capped at Sh1,000 and Sh2,000 annually for a household, noting that the allocation was too little, an issue that was backed by the committee chairperson.
"Providing Sh1,000 for a household for the entire year is unfair. This should be looked at," said Pukose.
PS Kimtai acknowledged the low allocation for the services and promised to have tariffs re-looked at.