Showcasing Concern For Health Care Costs in Kenya was every Kenyans’ responsibility. Today we will be looking at showcasing concern for the rising health care costs in Kenya. In the absence of an ethical and moral concern, the situation would only get worse. Surely, costs should not just keep on rising just because they can. Forces against any attempt at controls are exponential. But we must keep up the tempo and demand for fairness. Why bother? Because I believe this perspective matters – because it might well be your perspective, too.
Pic: A service charter of one rural health facility in Kenya
An EACC 40 page report on MOH after a systems audit 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. The 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.
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. Mark you these findings were mainly from public hospitals. It is beyond imagination how the private ones were outsmarting this.
Why care or who was concerned about escalating health care costs?
Fees for the same procedure in private hospitals varied greatly even across providers and geographical areas. It was not possible to convince anyone that the differences related to differences in practice costs as such. This had raised concern even among the health care providers themselves. “It’s insane to pay Ksh 300, 000 to give birth yet it’s a natural process, labour should not leave you in debt,” said Dr. O. M a 29-year-old general practitioner the proprietor of a private hospital in the outskirts of Nairobi. He added, “On average, we serve 60 patients every day and we are listed with all major insurance companies in Kenya including NHIF,” He added that patients could access some of the lowest possible cost to each service.
It is notable that there was an influx of private hospitals in the recent years. Most people had to raise funds to seek medical attention from the private sector due to the on going health crisis.
Clients themselves could be contributing to making health care costs high
Nevertheless, health care providers argued that there was another angle to this. At times clients themselves knowingly or unknowingly made the temptation to charge greater. As long as the patient deemed a treatment to be valuable, the care provider prescribed it (even if this wasn’t so great for the insurer!). They reasoned that as care providers they could always rationalize the patient’s demand for increased quantity of services. ‘However, there comes a point when he has to decide between additional incomes versus knowing that those increased quantity of services may not really be necessary’, added one medic who sought anonymity.
Who was benefiting from the overshoot of health care costs?
A fair question then would be, who do such practices benefit? Is it the client really? The answer seems obvious, that it was the medic and the facility they worked for. What of, if and when they decided to cost cut? Cost cutting for many entrepreneurs in healthcare was a question of whether the patient could afford and not a necessary a matter of principle. In some instances, the economic benefits of savings made may not be passed on to the client.
Rarely were the charge sheets authenticated nor were they folioed for audit tracking. Where folioing existed in the primary charge-sheet it was rarely meant for auditing purpose. There was a lot of transcribing of the charge sheet from the free hand to electronic with room for doctoring at every stage.
A good question at this juncture would be –
- Do all private hospitals have a standardized charge sheet?
- What would be so difficult coming up with one?
- Would a pricing policy help. There was one on drugs that was started in 1993 but was scrapped in 1994.
Why were consumer federations not concerned about rising health care costs?
Consumer federations were quiet on this very important aspect of the household expenditure for Kenyans, they seemed helpless or were perhaps otherwise compromised. Prices (of drugs among other consumables) were rising just because they can, not because they have to and nothing was holding them back. This meant hospitals and care providers can charge whatever they like. Value for money was important whether a third party was paying or not but defining this value was elusive.
Next, we will attempt to look at some suggestions on how to cure the insanity of runaway health care costs in Kenya. Now that Kenyans liked to talk democracy stuff, it is more democratic for the health care to be available for all and not a commodity to be purchased by a few.
The first part of this series covered health care costs in Kenya and whether they were largely driven by provider-induced demand, while the second part on whether or not health care costs in Kenya were driven by an insatiable demand 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