KMPDU rejects time-based restrictions on insurance claims pre-authorization

17 Mwezi wa kumi na mbili, 2025

Imeripotiwa na AI

The Kenya Medical Practitioners, Pharmacists and Dentists' Union has rejected a government proposal to impose time-based limits on insurance claims pre-authorization. The union argues that the healthcare system's challenges make such restrictions impractical. This comes amid efforts to curb doctors' private practices during official hours.

Kenya's healthcare sector faces ongoing tensions as the Kenya Medical Practitioners, Pharmacists and Dentists' Union (KMPDU) strongly opposes a proposed policy by Health Cabinet Secretary Aden Duale. On December 17, 2025, the union issued a statement criticizing the plan for the Social Health Authority (SHA) and Digital Health Authority (DHA) to reject pre-authorized insurance claims processed outside official working hours of 8 a.m. to 5 p.m. KMPDU contends that Duale has not consulted key stakeholders, including the union, before advancing this measure aimed at enhancing transparency.

The union highlights several systemic issues that render the proposal unfeasible, such as insufficient staffing, delayed payments to healthcare workers, intense workloads, and the absence of incentives. 'Concerns about accountability, conflicts of interest, and the prudent management of public and insurance resources are legitimate and warrant regulatory attention of the NEC,' the statement reads. KMPDU describes the fixed time-based rejection as 'operationally unrealistic and administratively arbitrary,' noting that staff shortages force practitioners into extended shifts and emergency duties, blurring the lines between on-duty and off-duty periods.

Calling for alignment with labor laws and the Collective Bargaining Agreement (CBA), the union demands meaningful consultations with healthcare sector representatives. It suggests alternatives like structured dual-practice frameworks or roster-based authorization to address concerns without disrupting services. This rejection follows Duale's announcement the previous day of a crackdown on doctors operating private clinics during government hours, which he labeled as fraud. 'It has become so rampant that doctors working in Government facilities are opting to send patients to private facilities they are operating in and either denying the facilities that pay them salaries or disregarding them completely,' Duale stated, emphasizing the impact on public hospitals' patients and revenue.

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Jumatatu, 2. Mwezi wa pili 2026, 01:56:58

KMPDU rejects time-based restrictions on insurance claims pre-authorization

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