Nairobi — The Social Health Authority (SHA) has stepped up efforts to streamline healthcare costs under the Public Officers Medical Scheme Fund (POMSF), launching tariff negotiations with hospitals in a move set to reshape reimbursement structures.

In a notice to contracted providers, SHA said it has finalized negotiations with Level 5 and Level 6 hospitals, with talks now shifting to Level 4 and Level 3 facilities under a phased rollout plan.

The process, guided by the POMSF Addendum, requires the authority to conduct a market analysis and agree on tariffs with healthcare providers before full implementation.

SHA Chief Executive Officer Mercy Mwangangi said the exercise will determine final pricing across services offered to public officers.

Keep up with the latest headlines on WhatsApp | LinkedIn

"The Authority shall conduct a market analysis during the first three months of the commencement of the POMSF Scheme and, following negotiations with healthcare facilities, provide final tariffs subject to approval by the SHA Board," she said.

She added that the approved tariffs will be implemented progressively within SHA's claims system, covering service access, claims submission, adjudication, and reimbursement.

Facilities that have accepted the negotiated rates will continue offering services under the agreed terms, ensuring continuity of care during the transition.

The reforms are expected to improve predictability in claims processing and reduce disputes between healthcare providers and the insurer, a long-standing challenge in Kenya's public health financing system.

SHA noted that the tariff-setting process is likely to be substantially completed within 21 days, subject to ongoing consultations.

The move forms part of broader reforms aimed at strengthening universal health coverage through more efficient financing models and improved alignment between healthcare providers and payers.