When most people think of healthcare, they picture doctors in white coats and hospital wards. 

But few imagine the quiet machinery behind it all, the approvals, claims, and coordination that determine whether care feels seamless or chaotic. Yet, it is this invisible infrastructure that often decides how quickly a patient is treated, whether a hospital stays solvent, and whether an insurer earns or loses public trust.

Across Kenya, patients still encounter unnecessary bureaucracy when they should be focused on recovery. Paperwork misplaced, approvals delayed, or data systems that do not speak to one another are indeed barriers to timely care. And in healthcare, inefficiency almost always has human costs.

Kenya spends about 5.2 per cent of its GDP on health, but out-of-pocket spending still makes up roughly a quarter of all medical expenses. That means that even as infrastructure grows and insurance coverage widens, inefficiency quietly taxes patients through time, stress, and preventable health risks.

Across the world, the problem is however, not unique. A McKinsey study found that up to 30 per cent of total healthcare expenditure is consumed by administrative processes rather than clinical care. In Kenya, the evidence is visible in manual claims, siloed hospital data, and legacy systems that slow down everything.

But the conversation on healthcare efficiency has moved beyond cost control. Increasingly, insurers and providers are investing in systems that make the patient experience faster, clearer, and less fragmented, proving that operational strength can be a form of care.

At Jubilee Health Insurance, we’ve chosen to confront that challenge head-on, through Re-Engineering the Care Experience. In 2024 alone we processed over 1.2 million medical transactions 

Our Artificial intelligence programmes now support parts of claims adjudication, cutting processing times by more than 40 per cent and easing the long-standing friction between hospitals and insurers over payments. Quicker settlement in turn allows providers to spend less time on paperwork and more time on patients.

Another quiet innovation has come through our structured care navigation where care managers now guide patients through the full process of treatment, diagnosis to drug delivery and home-based recovery that has in turn reduced hospital readmissions by up to 18 per cent.

Operational excellence, then, is not about machines working faster but systems working together. Insurers are uniquely placed to drive that transformation because they sit at the crossroads of data, funding, and patient flow

Collaboration will also determine how fast that change comes. Linking hospitals, pharmacies, and digital health providers into a single, interoperable network can cut fulfilment times and prevent duplication, a lesson drawn from pilot partnerships that have already halved post-discharge medication delays.

As Kenya moves towards Universal Health Coverage (UHC), the question will not be who builds more hospitals, but who builds smarter systems. 

By Dr Musa Misani - Chief Operating Officer (COO), Jubilee Health Insurance