The Split Between Volume and Cost Respiratory diseases accounted for 21.4% of all claims SHA processed between July 2025 and April 2026, driven largely by routine, low-cost illness. Cardiovascular disease tells the opposite story: heart disease represents 6.7% of claims but 14.8% of costs, making it the third most expensive condition by cost share nationally. Hypertension alone, the most common cardiovascular diagnosis, accounts for 6.1% of claims and 8.9% of costs. How Common Prehypertension Actually Is The scale of the underlying risk pool is larger than hypertension figures alone suggest. Kenya's hypertension prevalence among adults aged 18–69 is estimated at 24–29%, with roughly 50% of adults estimated to be pre-hypertensive. Only about a quarter of those affected are aware of their diagnosis, roughly 18% receive treatment, and just 7% achieve blood pressure control, according to peer-reviewed research on Kenyan healthcare facilities. Why the Cost Curve Keeps Climbing Hypertension is the leading global risk factor for mortality, and its progression to full cardiovascular disease, if uncontrolled, is what eventually drives the expensive claims captured in SHA's cost-share data. Kenya's low rates of diagnosis and control mean a large share of the population sits in exactly the pre-disease window where intervention is cheapest, and where SHA's current claims data offers no visibility at all, since undiagnosed and untreated hypertension doesn't generate a claim. The Kidney Disease Parallel Cardiovascular disease's cost pattern is not unique. Genitourinary conditions, dominated by chronic kidney disease, rank eighth by claim volume at 4.3% but account for 13.6% of total spending. Dialysis alone represents 2.6% of claims and 12.8% of all SHA spending, because a single dialysis patient generates two to three claims every week, indefinitely. Both conditions share a common origin: hypertension and diabetes are the leading drivers of both cardiovascular disease and chronic kidney disease in Kenya, meaning the same prevention gap is quietly inflating two of SHA's most expensive line items simultaneously. What This Means Going Forward None of this is an argument against treating cardiovascular disease once it develops. It's evidence that prevention spending, blood pressure screening, early hypertension management, doesn't show up in claims data the way dialysis and cardiac care do, but it's the only intervention that changes this ratio before it becomes unaffordable. Whether SHA's benefit design evolves to reward that kind of upstream investment, rather than simply paying for downstream crisis care, will determine whether Kenya's healthcare financing gap between common illness and expensive illness keeps widening. _Reporting sources: Daily Nation, SHA/SHIF Facility Payment Report (14 May 2026); PLOS One, Prevalence and Risk Factors of Hypertension in Kenya (2025); Kenya Ministry of Health._