Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors

Abstract

IntroductionThe prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients’ ability to pay for the services.Methods and findingsWe collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center—a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets.Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions ($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum).ConclusionsThere is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic burden that can result in catastrophic expenditures.

Breast cancer early detection: A phased approach to implementation

“…Financing of interventions for the early detection of breast cancer is justified from a public health, economic, and equity perspective. Numerous studies have documented the catastrophic health expenditures and economic hardships associated with a late‐stage diagnosis in patients with breast cancer in different world regions, regardless of resource level 55‐57 . There also are considerable nonmedical costs (transport, lodging, child care), which can account for up to 50% of total costs and must be taken into consideration to reduce the risk of impoverishment 55…”

Patient costs of hypertension care in public health care facilities in Kenya

“…In addition, it has been shown that households with a member with an NCD are two times more likely to incur catastrophic health expenditure compared with households where no member has an NCD . A minority of individuals (19%) in Kenya have health insurance coverage, and almost all employees in the formal sector, which is less than one‐fifth of those employed, are covered through the National Hospital Insurance Fund (NHIF) …”

“…16 A minority of individuals (19%) in Kenya have health insurance coverage, 17 and almost all employees in the formal sector, which is less than one-fifth of those employed, are covered through the National Hospital Insurance Fund (NHIF). 18,19 Several studies done in Kenya have identified a high prevalence of hypertension (ranging from 12.3% to 50.1%). 6,20,21 Examining the costs incurred by patients to access hypertension care is necessary as evidence suggests they are a barrier to access.…”

Situational analysis of breast health care systems: Why context matters

“…Insufficient infrastructure, geographic location, limited workforce capacity, and chronic underfunding can result in health systems that are ill‐equipped to manage the epidemiologic transition from communicable to noncommunicable diseases. This is compounded by financial barriers to access, including a lack of health insurance and high out‐of‐pocket payments and indirect costs 14‐18 . Unfavorable outcomes also are influenced by sociocultural factors, such as stigma, myths, language barriers, gender norms, discrimination, social class, and health literacy 11,15,16,19 .…”