For a patient who depends on dialysis, missing one treatment is not simply a financial inconvenience. It can quickly become a serious health risk.
That is why questions surrounding how dialysis is being paid for at Kenyatta National Hospital are attracting attention.
Families of renal patients say they are facing a confusing situation when a patient is admitted to the hospital.
According to complaints raised publicly, SHA may cover two dialysis sessions a week for an outpatient, but only one session when the same patient is admitted.
The difference has left some families wondering why admission should affect a patient’s access to dialysis benefits.
Under the published Social Health Authority renal care package, haemodialysis and haemodiafiltration are covered at KSh10,650 per session.
The package provides for two sessions every week, meaning a patient undergoing regular treatment can receive up to eight sessions in a four-week period.
However, families who have dealt with the issue at KNH claim that admitted patients may be told that only one dialysis session is covered. Any additional session, they say, has to be paid for privately.
One family member, Enock, said his cousin experienced this after being admitted to KNH.
He claimed the family was informed that SHA would pay for one dialysis session while the husband would have to meet the cost of the remaining sessions.
Attempts to seek clarification from the hospital reportedly did not change the position.
The concern is made more serious by the nature of dialysis itself. Patients whose kidneys have failed rely on regular treatment to remove waste and excess fluid from their blood.
It is therefore difficult for families to treat an unpaid session as something that can simply be postponed.
The SHA rules also appear to distinguish renal care from general inpatient services. Renal care is listed as a separate package covering dialysis, specialist review, nursing services, laboratory tests, medication and other related treatment.
General inpatient care, meanwhile, is reimbursed through a daily payment system.This has raised a key question: does being admitted to KNH legally reduce the number of dialysis sessions covered under the separate renal package?
If there is a specific SHA policy limiting admitted patients to one covered session, patients and their families need a clear explanation of where that rule is contained.
If no such restriction exists, then SHA and KNH should explain why families are being asked to pay cash for additional treatment.
For households already struggling with the cost of long-term kidney care, an extra bill of more than KSh10,000 can be extremely difficult to raise.
The issue therefore deserves a clear response from both SHA and the Ministry of Health. Patients should not have to guess whether an essential treatment is covered simply because their medical condition has required them to be admitted to hospital.
