Doctors accuse insurance companies of dictating patient's choice of hospitals

Pharmacists and Dentists Union Secretary-General Davji Atellah addresses a press conference in Nairobi alongside Union of Kenya Civil Servants officials. [File, Standard]

Doctors have strongly condemned insurance companies for what they term as interference in healthcare delivery, accusing them of acting like “chief controllers” of the health system.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) Secretary-General Dr Davji Atellah has said insurers are overstepping their mandate by dictating where patients should seek treatment, which doctors they should consult, and even which tests and drugs should be administered.

“This is wrong, unethical and illegal,” said Atellah. “A patient has the right to choose any hospital or doctor they feel will help them. Insurance companies have no business determining what tests or treatments a patient should receive.”

According to doctors, insurers have increasingly restricted access to healthcare by refusing to authorise certain procedures, delaying payments to hospitals, and blacklisting facilities.

In Eldoret, the union noted, a patient scheduled for a procedure at War Memorial Hospital died after delays caused by insurance restrictions.

The life of the patient could have been saved.

Keep Reading

“They have grown bolder. Recently, they even united to direct patients not to seek services at Nairobi Hospital. No hospital will be safe if their appetite for profit continues,” warned the union official.

Last week, at least 12 insurance firms suspended services at The Nairobi's hospital alleging hike in charges for diagnostic and treatment.

The hospital said the move was because of high cost of medical and pharmaceutical commodities.

Insurance firms maintained they are not able to cater for the hiked tariffs and further directed their clients to seek care in other hospitals.

Solutions between insurance firms and the hospital management on the matter is yet to be found.

Apart from The Nairobi Hospital, insurance firms are accused of interference in Vihiga, Kiambu and Trans Nzoia among other counties.

Doctors allege that insurance companies are motivated purely by greed, raising premiums while at the same time withholding payment for services.

Atellah however acknowledged high cost of care, but maintained the move by insurance covers to unit against provision of quality healthcare remains unethical.

READ: KMPDU warns against dismissal threats as doctors strike in Kiambu

“They are profit-making enterprises. Their bottom line is not patients’ health, but maximising profits. They look for loopholes to avoid paying claims, at the expense of Kenyans’ lives,” added Atellah.

The union also accused insurers of demanding kickbacks from hospitals and doctors before settling claims, a practice they say compromises quality of care.

“These companies owe hospitals millions, yet they don’t care about the outcomes for patients. Instead, they blackmail facilities and doctors, threatening to delist them if they speak out,” Dr Atellah said, adding that many healthcare providers fear exposing the malpractice.

KMPDU announced it is compiling complaints from doctors, patients, and hospitals to present to the Insurance Regulatory Authority (IRA) within two weeks.

The union has further threatened to take legal action against companies found guilty of malpractice.

“As a country, we must demand transparency and accountability. Insurance is meant to protect patients, not to control healthcare for profit,” said Atellah