SHA clarifies why patients with same illness receive different care packages

A story published by the Daily Nation on Tuesday raised concerns about how many patients, without connections to influential figures, find themselves disadvantaged as they receive lower package approvals compared to those with access to higher authorisation. 

In a swift rebuttal, SHA explained that two patients may share a broad diagnosis and visit the same hospital but incur different approvals as their clinical profiles, diagnostic needs and treatment pathways differ.

In a detailed explanation of the pre-authorisation process for two patients diagnosed with cancer, SHA stated that their applications are processed through an automated digital system. 

"Individual staff members don't have the ability to arbitrarily adjust approvals," the statement read in part. 

Several factors affect the approval process, such as the stage of care, balance within the annual oncology package, complexity of the case, completeness and structure of the request submitted by the hospital and the choice of the facility. 

"As a result, differences in approvals don't imply preferential treatment, but reflect the application of uniform benefit rules to differing clinical circumstances," SHA added. 

SHA condemned preferential access to the packages, noting that any system manipulation will be investigated.

Further, SHA revealed ongoing efforts to improve access to cancer care by embedding the National Cancer Control Programme (NCCP). 

"This will support more standardised diagnostic panels, clearer provider submissions and improved patient experience."