Rising Health Care Costs in Kenya and How to Cure the Insanity

There must be found a way to cure the insanity of rising health care costs in Kenya. Many Kenyans were upset with recent revelations Ethics and Anti-corruption Commission (EACC) 40 page report on MOH after a systems audit aimed to seal loopholes of corruption was launched in March 2017 report released on 17th August 2018 by Arc Bishop Wabukala to CS Health Cicely Kariuki.

The picture above: Members of the community scrambling for some tablets. Meager resources characterized the health systems in Kenya  [Courtesy of Community Eye Health Update 6]

Unearthed disparities of cost. Cost of say Panadol 500mg varied from 10bob in Nairobi to 400 in Lodwar. An anti-ulcer 500mg drug KEMSA ksh840, ksh1300 at coast county referral, ksh2400 Nakuru referral.

An item that cost ksh 700 at KEMSA level sold/ charged at Ksh 35,000 by hospitals.  Health facilities apply different price mark-ups ranging from 10-30percent for medicines and other supplies.

Also showed how hospitals were fleecing insurance providers

A database of health care prices generally does not yet exist in Kenya at the moment, but it can be created just as we do with other markets/stocks, why and why not? It was a matter of policy because health care costs Kenyans (insured or not) a lot of money.

Today we look at rising health care costs in Kenya and some suggestions on how to cure the insanity. Last time we covered showcasing concern for health care costs in Kenya.

The following statement was adopted from PriceCheck, a community-created guide to health costs in the US, ‘Buying health care is like going to the supermarket and finding all the price tags removed. Even worse, an item that might cost you Ksh50 to another shopper it would cost Ksh200, and you wouldn’t know which until you got to the teller’s counter‘. By collecting information from you and others like you, we can help change that…share what you paid’. What incentives could be made available (if at all for Kenya) for monitoring, profiling service providers, limiting services, to keeping costs low?

The concern for doing something about provider induced demand should be mainly targeted to Kenyans who happened to be well insured and could afford to choose how they interacted with the health system. For a majority of those who paid out-of-pocket or had the bare-bones type of medical cover, accessing any meaningful health care was a luxury. But they too needed to learn how to interrogate the bill.

Pic: Tick insured or uninsured [Courtesy of 123RF]

This raises more questions than answers:

  1. Would a well-insured Kenyan generally opt for the lowest-cost option (to them) that met their needs?
  2. Would they be interested in cost saving in the first place?
  3. Would we be asking our practitioners to forego such a significant revenue if we thought of it in terms of the country’s economy and the people?
  4. Would a policy help to recoup something from these private outfits for the benefit of the less fortunate, or would this again drive up costs?
  5. Would they be willing to make a contribution so others with less means still have access to healthcare?

This is what Sarah Dods (The Conversation March 6, 2014), wrote concerning Australia – ‘there was a need to encourage better utilization of lower cost parts of the health-care system that met patients’ needs by all sectors of the population’. Sarah Dods is a research theme leader with (Commonwealth Scientific and Industrial Research Organisation) CSIRO. This raises fundamental questions:

  1. Does health insurance as currently run in Kenya cut costs in the long run?
  2. What incentives would prevent providers from charging “higher-income” patients more fees?

Heath was a priority aspiration in all societies. In the US, President Obama ran on this agenda and he would be remembered for the ObamaCare. Australians in their run-up to the nation’s 2012 elections clearly placed health care ahead of other key policy areas including keeping the national economy strong, employment and infrastructure.

Statistics in health care matters alot to them, but I really doubt that statistics will make a difference in our leadership here in Kenya.  No doubt there were statistics available to show the effect of the ongoing health crisis to healthcare and its effect on people. But not many people will pay attention! Too bad.

The common denominator with a lot of issues is the lack of regard for human life and the people in authority don’t care about the common mwananchi. For us, the state of health was not as important as the State of the Nation. It was unfortunate that in Kenya the presidential elections and the general elections 2017 ran alongside stuff like #HealthcrisisKe. Despite the crisis facing the health sector, no single item was on health among those passed in the last supplementary budget.  The national nurses’ strike, was now on the 135th day and counting. It was unfortunate that lives dont matter anymore.

Nurses were agitating for the signing of their collective bargain agreement (CBA) which needed Ksh 7.3b to implement. The nurses had to plan carefully lest their demos clashed with those agitating for electoral reforms. To the political class, this strike was obviously a nuisance. The politics going on were making it hard to get audience with the right people. The political hypes were unfavourable for any fruitful talks, the political as well as industrial stalemates  will be resolved once the government gets back serious business. See http://www.compleathealthsystems.com/uncategorized/health-care-kenya-viable-currency-political-negotiation/

Pic: Nurses demonstrating at Uhuru Park Nairobi 
[Courtesy of MoH on Twitter]

We needed to look for ways to deliver high-quality care with good patient outcomes at an affordable cost to the country. In view of the vision to transition towards a middle-income status, we need to remain true to ourselves. Health is a basic right as enshrined in the constitution, Sustainable Development Goals (SDGs), Vision 2030 and a myriad of strategic papers and frameworks. Health For All ought to be a reality. It’s the people that matter, the people of Kenya.

It had been variously thought that Universal Health Cover (UHC) was the key solution out of this mess as it would make health care affordable to ALL (or was it to the average Kenyan?). We will look at this next time.

The first part of this series covered health care costs in Kenya and whether they were largely driven by provider-induced demand, while in the second part whether or not health care costs in Kenya were driven by an insatiable appetite to make more profit? Interrogating your hospital bill was covered in a related post.

Read on universal health care for Kenya. What should come first the cover or the care? Please follow link

 

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