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HEALTH FINANCING UNIT

ANNUAL PERFORMANCE REVIEW FY2024/2025

at

NICE DIGITAL CITY

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INTRODUCTION

  • Health financing is one of the key pillars of the health system concerned with mobilization, accumulation and allocation of financial resorces to cover the health needs of the people.

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  • A good health financing mechanism makes funding available and sets the right financial incentives to providers; to ensure all individuals have access to effective healthcare services.
  • It involves resource mobilization, allocation and distribution to all levels; National & Local

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REVENUE PERFORMANCE SUMMARY FY 24/25

REVENUE PERFORMANCE SUMMARY 2024/2025

REVENUE SOURCE

FY. 2024/2025

PROJECTION FY.2024/2025

ACHIEVEMENT RATE (%)

Kerugoya County Referral Hospital

265,999,152.00

158,000,000

168.35

Kimbimbi Subcounty Hospital

59,153,262.00

28,000,000

211.26

Kianyaga Subcounty Hospital

24,917,784.00

15,000,000

166.12

Sagana Subcounty Hospital

15,257,670.00

9,500,000

160.61

Rural Health Facilities

67,097,306.24

7,500,000

894.63

TOTAL

432,425,174.24

218,000,000.00

198.36

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REVENUE PERFORMANCE CONT’

  • Higher revenue collection in all health facilities in FY24/25(432,425,174.24) compared to FY 23/24(237,097800.00).

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  • All health facilities surpassed their targets in FY 2024/2025

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  • Timely reimbursements from SHA contributed to improved revenue collection

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SHA CLAIMS VS PAYMENTS FY 24/25; HOSPITALS PERSPECTIVE

  • All hospitals were paid more than half of the claims submitted
  • On average, about 71% of the total submitted claims were paid in FY 2024/2025

FACILITY

CLAIMS

PAYMENT

%

KCRH

192,533,150.00

143,682,586.00

74.63

KIMBIMBI

45,594,407.00

26,283,494.50

57.65

KIANYAGA

16,662,340.00

10,737,033.00

64.44

SAGANA

4,934,430.00

3,111,284.50

63.05

TOTAL

259,724,327.00

183,814,398.00

70.77

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REJECTIONS

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Reasons for Rejections

  • Missing Mandatory documents(Attachments; Claim form, itemized invoice, Discharge summary)
  • Upcoding of services
  • Mismatched Services
  • Use of wrong claim form

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FACILITY

CLAIMED

REJECTED

%

KCRH

192,533,150.00

2,931,840.00

1.52

KIMBIMBI

45,594,407.00

7,293,360.00

16.00

KIANYAGA

16,662,340.00

2,256,000.00

13.54

SAGANA

4,934,430.00

110,800.00

2.25

TOTAL

259,724,327.00

12,592,000.00

4.85

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CLAIMING RATE; LEVEL 2 & 3 HEALTH FACILITIES

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CLAIMING RATE; LEVEL 2 & 3 HEALTH FACILITIES CONT’

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CLAIMING RATE; LEVEL 2 & 3 HEALTH FACILITIES CONT’

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CLAIMING RATE; LEVEL 2 & 3 HEALTH FACILITIES CONT’

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CLAIMING RATE; LEVEL 2 & 3 HEALTH FACILITIES CONT’

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WAIVERS

WAIVERS REPORT

HOSPITAL

FY23/24

FY24/25

KERUGOYA COUNTY REFERRAL HOSPITAL

9,818,856.00

11,140,496.00

KIMBIMBI SUBCOUNTY HOSPITAL

1,262,965.00

2,601,120.00

KIANYAGA SUBCOUNTY HOSPITAL

172,010.00

303,855.00

SAGANA SUBCOUNTY HOSPITAL

249,770.00

261,275.00

TOTAL

11,503,601.00

14,306,746.00

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THE END.

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THANK YOU!