The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has accused insurance companies of colluding with cartels in denying Kenyans access to quality healthcare, vowing to publish a “List of Shame” within the near future to expose the offenders.
Publishing a strongly worded statement on Tuesday, August 19, the doctors’ union alleged that insurers positioned themselves as the gatekeepers between patients and their doctors, informing Kenyans what kind of treatment to have.
According to the union, insurance firms are increasingly deciding which hospitals patients can visit, which doctors they may consult, and even which tests or drugs they can receive regardless of the medical need.
“Insurance cartels are standing between doctors and their patients, denying Kenyans quality healthcare,” KMPDU said.
The union also accused insurers of delaying claim settlements, often forcing patients to dig into their own pockets. In some cases, hospitals under the Social Health Authority (SHA) scheme have allegedly been compelled to pay bills upfront, undermining the government’s push for Universal Health Coverage (UHC).
Another concern raised is the rising cost of premiums even as insurers continue to cap the fees paid to healthcare providers. KMPDU argued that this not only limits access to quality care but also leaves doctors overstretched in underfunded hospitals.
The union further accused regulators including the Insurance Regulatory Authority (IRA) and the Competition Authority of Kenya (CAK) of turning a blind eye to malpractice.
“Big insurance companies are blackmailing healthcare providers, and regulators have failed to act,” the statement read.
The union’s warning comes amid ongoing scrutiny of the SHA programme. Earlier this month, Health Cabinet Secretary Aden Duale suspended more than 40 health facilities from the scheme over alleged fraud, saying they would only be reinstated once they complied with regulations.
KMPDU insists that unless the insurance sector is cleaned up, patients will continue to bear the brunt of a system that prioritizes profit over care.
