Skip to main content

To ensure emergency hospital admissions for all, Kenya needs to pay hospitals

An accident scene on Mombasa Road.
Many emergency hospital admissions are usually from such scenes, with the
patient barely conscious and neither in a state to settle out formalities of  payment
before admission. 
Last week, we were confronted with the story of a patient who spent 18 hours in an ambulance, waiting for medical care. The road accident victim,  who needed Intensive Care Unit admission, found our national referral hospital - Kenyatta National Hospital, did not have any vacant ICU slot. It is said other private hospitals refused to admit the patient, though only one hospital got mentioned in the incident.


Though one may be forgiven to think that this was just a single occurrence - the feeling is that the situation occurs quite often, and that the case here only happened to stand out by making it to the newspapers.


Kenyans are outraged. They feel that hospitals, especially private ones, that refuse to admit patients before a payment deposit is made, are being greedy. They feel that such hospitals should not be driven by pursuit of money, and instead, should offer treatment first, then pursue money later. They feel that a hospital insisting on a deposit for treatment is breaking the Hippocratic oath, and not being humane.


There have been calls for stringent laws to ensure that hospitals don’t turn patients away because of inability to pay. We have been here before, and I believe there are existing guidelines or laws that direct hospitals to take in patients first, and deal with payments later. That these do not work shows that there is a problem. Furthermore, trying to reimplement the same is likely to run into the same challenges, sooner or later.

I disagree with the view that hospitals are purely driven by greed. Private hospitals are just doing what is essential for their survival.


I was recently discussing the same issue with a friend. He gave me two stories which allegedly took pace.


A retailer at Gikomba Market was once knocked down by a car, and then driven to M.P. Shah Hospital by a good Samaritan. The family only got aware of the incident when contacted by the hospital. They did not even know who had brought their kin to the hospital. Meanwhile, they had a rising medical bill.


They quickly convened a fundraising, which raised KSh. 1.2 million. The retailer’s counterparts in Gikomba market also had a fundraising that raised about 3 million shillings, which both helped clear a huge portion of the patient’s bill.


He then gave me another tale of a patient who had been admitted at a Metropolitan Hospital. On noticing the patient’s conditions was deteriorating, the family requested the hospital to transfer the patient to Kenyatta National Hospital, and that they would settle the bill later. The hospital agreed and duly ferried the patient to KNH in their ambulance.


Metropolitan Hospital later called the family to follow up on their payment. This wasn't made, and further efforts by the hospital to follow up on the matter saw the contact they had eventually permanently switch off the phone - leaving the hospital with no way to contact the patient’s family.


The tale would have ended there, had the hospital’s employee not been reading the papers on a given day. In the obituary section, they spotted the runaway patient, and noted a burial date had been set at Langata Cemetery. He turned up for the funeral, and reminded the grieving family of their obligations.


For most of us, we picture that most scenarios tend to fall in the former one, with happy endings. That though may not be the case.


A visit to Langata Cemetery will indicate that there is a large section reserved for the unclaimed dead. A visit to many hospitals, especially government ones, will reveal a group of abandoned patients - who long ago recovered, but have had no one to pay their bill and get them discharged.


It is therefore quite common for Kenyans to abandon their kin in hospitals when faced with high bills.


Hospital admission does not come cheap. Admission to intensive care in any hospital will set you back at more than what it costs for a stay at top Kenyan hotels. Given how many Kenyans can even afford a cup of tea in these hotels, try picture the same faced with such bills.


At the same time, a high accident rate and unaffordable health care in Kenya means most of us are likely to find ourselves in a hospital bed. For a good number of us, this involves been taken to hospital by strangers in some state of unconsciousness.


You therefore understand our uneasiness at the prospect of a hospital refusing to admit us because we can’t cough up huge deposits.


The state of healthcare in the country means that most public hospitals lack enough resources - especially bed spaces, or medical supplies, to take in critically ill/injured patients. Years of under investment in public healthcare have taken their toll.


In fact, we are lucky that the emergence of charity ambulance services - the likes of Kenya Red Cross, St. John and Swift,  among others, mean that there is a better chance we may get to hospital in time. Some local governments have also invested in their own ambulance services - but these tend to be described as mere public service transport vehicles for the ill. Many lack the resources needed to sustain a patient on the balance of life and death - bar the ones I mentioned earlier.


Private hospitals are in a better position compared to public hospitals. They however, are reluctant to take in patients without proof that their bills can be catered for.


You see, the reasons private hospitals are in a better position is that they have been investing in facilities, resources and supplies. Some have taken huge loans to invest in expensive medical machinery. Such institutions can find themselves unable to pay their bills if a small number of patients default on their bills. Their options would be to load such bills on everyone else - thus becoming more unaffordable, or to shut down.


Our options then are to either ensure that public hospitals have enough emergency capacity, or ensure that private hospitals get paid for their kind deeds.


Even better, we need to come up with a way of paying hospitals for emergency healthcare patients that they take in -be they private or public. You see, even public hospitals have costs, and under investment is what has left many of them unable to admit critically ill patients. Operating theatres and ICUs are expensive to run.


If we have the resources to bail out sugar factories and airlines - I do believe we can allocate money for the health of Kenyans. If we have money to build a railway,  we should have enough to ensure that Kenyans are healthy enough to use one.


One way in which this can be done is by having the National Hospital Insurance Fund (NHIF) take up the role of funding such cases. After all, what is the role of a Government owned medical fund, if the people can’t get admitted when ill. NHIF, can for example,  guarantee to cover at least 2 days of emergency admission in a number of private hospitals.


By the second day, it should be hoped that the patient can then be transferred to a more affordable government owned institution like KNH, or if able, have figured out a way to continue their stay at the institution that took them in.


Alternatively, the government can set out a bail out fund that will directly go to hospitals that had to take in patients,  who in turn couldn’t afford the bills in such hospitals. Such a fund may present some challenges in administering - but I believe that it can be done.


Either way, we have options besides calling hospitals greedy. We need these hospitals in the future, and thus must ensure they are able to not only offer medical care, but also pay expenses they incur in the process.


These are what I’d call stop gap measures, which can be implemented for now. In the long term, I believe a permanent cure of our ailing hospitals would be a basic insurance scheme for all, subsidised by government for the poor. Such as scheme should entail the doing away with of the NHIF, or privatisation of the institution. That though,  is the subject of another post.

Meanwhile, to get life saving healthcare for all, we have a larger part to play beyond just passing laws. We need to dip into our pockets and back those laws up.




Comments

Popular posts from this blog

The bitter story of the downfall of Mumias Sugar company

Have you heard the bitter story of Mumias Sugar?

Regarded by many as Kenya's most successful sugar miller, Mumias Sugar Company was a disaster waiting to happen.

Many pointed out how Mumias Sugar Company was a fortress in the wreck that is Kenya's sugar industry, only unaware that it was just a matter of time. As the old wise men said, "Ukiona cha mwenzako cha nyolewa, tia chako maji".

The proverb means that if you see your neighbour's head getting shaved, your head will soon be undergoing the same - you'd therefore better wet your head for a smoother shave, otherwise you will be forced to undergo a painful, dry, shave.

But what ails Kenya's sugar industry?

The Kenya sugar industry is under legal siege. The typical Kenyan issue of coming up with laws to tackle a problem is evident here.

Many of Kenya's sugar factories are owned by the government, and have slowly declined under mismanagement and corruption. The appointing of political cronies and trib…

Tuskys Bread Versus Ukwala Sukuma Wiki

Ukwala is a relatively cheapaffordable supermarket. The exact same good sold in Nakumatt, Tuskys and Ukwala chain of stores will most of the time cost less in Ukwala. For example, I was recently looking at a Kenpoly Plastic rack that comes with 3,4,5 or 6 compartments that I saw in a friends house.

My friend, wait, colleagues says that the rack set him slightly more than kshs 2000 at Nakumatt. It is quite a good looking rack and adds up to the spruced up appearance of his house.Why he doesn't have a girlfriend beats me.n This is not to say I have one, neither do I deny.Also,my house is the equivalent of the Commonwealth Games in India,something a relative once described as a dustbin, and for this reason , "No Visitors" policy remains.

Back to the Kenpoly rack, the rack is available in most Nakumatt stores and at least one Ukwala store that I visited. As for Tuskys, I have never figured how they operate big stores that competing stores beat when it comes to variety. For t…

How I lost my phone to Nairobi's best con man

A good con requires the highest level of cooperation from the victim.

*** I lost my phone on Friday evening, some time between 6:40 p.m. and 7:10 p.m. I know the time because my receipt indicates I was served at Ukwala Supermaket, Tom Mboya at 6:32 p.m., on the 26th of February, 2016.

Given I'm a brisk walker who avoids crowds, it should not have taken me more than five minutes to get to the area around the Tom Mboya statue on Moi Avenue,  just opposite the Hilton.

My habit of avoiding crowds is what led to what became a tragic decision, to walk along the road and emerge at the bus stop next to Ambassadeur Hotel, rather than walk along the pavement. It is here that I bumped into the villain, Nairobi’s best con man. He was running, kicking a plastic bottle along the road.

He said something to me that I didn't catch, to which I responded with a “huh”? It was only the two of us and lots of buses, for everyone else was using the zebra crossing next to Pizza Inn, then walking past t…

The Bible. Why you should read your Bible.

After reading what The Candid Tin man had to say about the Bible on his blog, I felt a disappointed man. In my opinion, the candid Tin man had committed the same errors of omission and commission that have plagued the Bible for centuries.

In the beginning, the Roman Catholic church was the dominant church worldwide, and the bible existed in Latin language which common folk like me and you did not understand. Latin was a dead language used by the priests of the roman Catholic church and perhaps a few scholars.

The Roman Catholic church aimed at controlling the public's opinion , as the church still does today, and especially their opinion of what was God's word. Therefore, back then, if you needed to understand God's word, you had to consult the Roman Catholic Priests to read the Bible for youa nd then tell you what it said. How well they did this and their intentions remained questionable, with accusations directed at the Roman Catholic Church for mistranslating The Bible…

Kenyan products: The art of punishing your consumer

Peanut butter used to taste so good, but you could not afford it on the pocket money that you got back in school. A few years later, you have your first real job and your first "disposable" income. You buy your first real tub of peanut butter , probably the first in your life. You feel proud that Dominion peanut butter is manufactured in Ruiru, a town that you visited in your campus days to withdraw your pocket money , it was the nearest bank ATM to your campus. This was before Equity bank became a mainstream bank and decided to open an ATM in your campus, and before M-Pesa meant that you could withdraw your pocket money next to the kibanda  where you had your one meal of the day.

The peanut butter though is a far cry form the peanut butter you remember. It does not taste that good, and turns into some sort of stone barely before you are a third way through the jar. The stone is not a kind that you learned about in your Geography classes though.

Dejectedly, you decide not …