An investigation by Africa Uncensored, Lighthouse Reports, and the Guardian has revealed that Kenya's AI-powered healthcare system, launched in October 2024 as a key electoral promise of President William Ruto, systematically overcharges the poorest citizens while undercharging the wealthiest.
The system, designed to replace Kenya's decades-old national insurance and expand coverage to the 83% of workers in the informal economy, uses a machine learning algorithm based on proxy means testing (PMT). This method estimates household income by assessing assets such as roofing material, toilet type, and ownership of items like radios.
Investigators found that the algorithm overestimates the incomes of poor households by as much as double, forcing them to pay premiums equivalent to 10-20% of their meager earnings. Meanwhile, the incomes of wealthy households are underestimated, allowing them to pay less than they should. Grace Amani, a government volunteer registering households, reported that critically ill people are dying at home because they cannot afford the premiums set by the system.
David Khaoya, a health economist who advised the health ministry, stated that the government chose to prioritize accurate assessment of the wealthy, even at the cost of overcharging the poor. 'If you identify a richer person as poor and therefore ask him to pay less, this person will never own up,' he said.
A pre-implementation report by IDinsight, obtained by reporters, warned that the system was 'inequitable, particularly for low-income households' and based on outdated data. Despite this, Kenya deployed the system. Of over 20 million registered, only 5 million are paying regularly. Hospitals report large deficits due to unpaid reimbursements.
Dr. Brian Lishenga, chair of Kenya's Rural and Urban Private Hospitals Association, called the system 'an experiment that has failed' and 'a great tool for helping the government run away from responsibility.' Former Deputy President Rigathi Gachagua predicted the system would collapse within six months. Development economist Stephen Kidd noted that similar PMT systems have failed globally, with error rates as high as 90% in some countries.
Source: www.theguardian.com