It was past midnight on Saturday when Chege Okach (not his real name) received a call from his sister-in-law. The late night call was to notify him that his brother was not feeling well. He was requested to come over immediately.
Okach rushed to his brother’s home, just a kilometer away. On arrival, he found that his elder brother had stabilised from the disturbing medical condition. He was told his brother was sweating profusely and had breathing difficulties. The family later on decided to take him to hospital for professional opinion.
Okach’s brother, who we also refer to as Okach had for long been diabetic and the family suspected this could have been the cause of the sudden attack. He was diagnosed with diabetes in 2000 and has since lived with the lifestyle disease. On arrival at Aga Khan University Hospital in Nairobi for a checkup, the doctor, after carrying out preliminary tests, confirmed to the family that Okach suffered a mild stroke and had to be admitted immediately as chances were high a second major attack could follow momentarily.
But what was to follow shocked the family. At the reception where the patient details had to be processed before admission, the hospital attendant declined to admit Okach unless the family deposited Sh700,000 cash, notwithstanding it was way past mid-night and a weekend at that. Okach, who is a retired worker, had no medical cover, which worsened things.
The family spent several minutes pleading with the admitting personnel to have Okach who was by that time critically-ill admitted, but to no avail. The family could only raise Sh40,000, which they withdrew from an ATM at the hospital. This, however, was not enough to admit Okach to the specialised Intensive Care Unit (ICU) for overnight under emergency care.
“The money you have is far from the Sh700,000 needed for admission,” the family quoted the staff as saying.
Investigation by the Financial Standard later established that the huge demand for deposit is across all the major hospitals and not limited to Aga Khan alone. At Nairobi Hospital, the deposit required for ICU stands at about Sh600,000, the same as for Mater Hospital, while MP Shah’s stands at Sh450,000.
Bed charges at the ICU facilities per day range between Sh35,000 and Sh45,000. At the Kenyatta National Hospital (KNH), deposit for high Dependency Unit (HDC) stands at Sh200,000, while bed charges per night stand at Sh15,000. Deposit for normal admission at its private wing stands at Sh150,000 where bed charges per night are Sh4,000.
Okach was finally admitted, only after the intervention of the doctor and a promise by the family that they would do all in their powers to raise the amount on Monday (the following day) when banks and business are open.
“It was impossible to raise the amount demanded by the hospital at that particular time,” explained the family. The doctor was kind enough to explain to them that the hospital was avoiding risk of default , which is widespread and thus requires a certain amount of downpayment, depending on the treatment required. For ICU and other serious treatment, not less than Sh700,000 must be deposited.
These, the hospital attendant said, are rules that he must obey although not written down in their books. He reminded the family that he would be in trouble if they failed to bring the cash as promised.
He was also quick to point out that if Okach recovered quickly, the hospital would certainly refund the balance outstanding from the deposit. This was never the case. Okach had to top up Sh400,050 on his medical bill when he was discharged.
But what Kenyans and most patients may not know is depending on the deposit you make, this tends to reveal the patient’s ability to pay.
The medics will ensure that all manner of tests and medical care are given to the patient. All these come at a cost. Aware that their expenses are fully covered by the deposit, the patient normally ends up topping the deposit and very rare he or she gets any refund.
That raises the ultimate patient money question: How can the country reduce health care costs while not compromising quality?
In another scenario, on the evening of March 5, 11 month old Angie arrived at Gertrude’s Children Hospital in Muthaiga in an ambulance. She was in critical condition, experiencing seizures, and in dire need of the ICU services. The hospital could however not just take her in. Her parents had to deposit some Sh300,000 for Angie to get a bed at the ICU.
It was after pleading and promising by Angie’s parents to deliver the funds the following day as well as a confirmation that the couple had slightly over Sh200,000 left on their medical insurance cover that the hospital took in the child.
Angie had developed the cough that had been coming and going for about a month. Her parents had sunk numerous hours taking to different hospitals, where she had undergone numerous tests and given prescriptions, according to her father John, which had nearly depleted funds on the young family’s insurance cover.
On March 4, the bout of cough was a notch higher and John and his wife decided to try yet another hospital in the hope that the doctors would be able to root it out. At the new hospital, a reputable one that is less than five kilometres from Nairobi’s city centre, Angie was admitted and a few tests were done but nothing out of the ordinary showed up. Like the previous hospitals, the doctors prescribed same medicine and asked that she stay in the hospital a day more for further observation.
It was during the second night that the child’s condition worsened, coughing incessantly and eventually started experiencing seizures. There was no bed available at that particular hospital’s ICU ward and the administration offered to help look for an ICU bed in other hospitals.
This is how the couple and their daughter showed up at Gertrude’s just before midnight on March 5. The child was admitted after the promise to deliver Sh300,000 the following day. The medics at Gertrude’s were able to stabilise the child and following a few days at the hospital, Angie was diagnosed with meningitis and started treatment. Despite a month of treating Angie, she did not make it and passed on, on the night of March 29. In addition to the Sh300,000 that John managed to raise and pay to the hospital, he has been given a Sh3 million bill for the tests and treatment that Angie went through while admitted at the hospital.
This is the cry of the country’s patients which need no explanation. Given the high medical costs, more than 200,000 financially sound Kenyans are being pushed into abject poverty each month by exorbitant medical bills leveled against them by major health facilities.
Most hit are patients requiring emergency or Intensive Care Unit services, with many hospitals demanding cash deposit before treatment.
Such an on demand deposit could range anywhere from Sh10,000 to Sh1,000,000, depending on the nature of treatment or level of hospital.
It also means the difference between life and death. This happened to the late Alex Madaga, an accident victim who died in 2015 after being kept in an ambulance for 18 hours due to his inability to raise Sh200,000 cash deposit demanded by the hospital.
The sole bread-winner, Madaga left a destitute family which is still fighting to get justice from Kenyatta National Hospital and the Coptic Hospital.
This is at a time the constitution and a Patients’ Charter guarantees emergency care to every Kenyan irrespective of the patient’s financial status.
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The Ministry of Health’s 2015 Catastrophic Health Expenditures and Impoverishment in Kenya survey shows that medical bills are turning 2.5 million Kenyans from bread winners into paupers annually.
In another example, some 35,000 Kenyans who recently sought treatment at Moi Teaching and Referral Hospital in Eldoret may have been forcefully pushed out of the formal economy. “There are over 35,000 Identity Cards being held at the facility alone due to unpaid bills,” Isaac Chirchir, the MCA for Soy Ward in Uasin Gishu County told the media recently.
Chirchir was telling of the Motion he had moved at the County Assembly to compel medical facilities in the region to waive bills of the affected patients. He estimated some other 10,000 IDs could be in the hands of other health facilities in the county.
City lawyer Alfred Onditi however observes that people denied possession of IDs are totally disenfranchised from mainstream economic and social activities.
Anecdotal evidence shows health related indebtedness as the major reason many Kenyans are selling off family property. “It has spawned off a totally new kind of business for the hotel and hospitality industry,” says Esther Kahinga, manager at a two star Nairobi City hotel.
“On average, we are running 16-group meetings daily; most of them fund raisers for medical bills.” This portfolio, she says is doing much better than the meals and accommodation sections combined. Ms Kahinga says alongside medical bills, such groups are also collecting are burial expenses. The 2015 Kenya National Economic Survey showed more people died of illness in Kenya than at any other time in the past five years.
“It is not if, debilitating bills will hit a family, but just a matter of when,” says Dr Diana Njeri Kimani of the University of Nairobi and consultant Thomas Maina in the Catastrophic Health Expenditure report.
This may be the only and most comprehensive report which shows how Kenya’s health system has turned around to cannibalise patients and their families.
For the hospital management, part of the reason why health care spending is going up so fast is prices for everything ranging from health care labour to drugs and CT scanners whose costs have been skyrocketing. But the more worrisome reason for rising spending is the quantity of high technology, specialty services that they have to install.
“We get more high tech imaging studies, more days in the ICU, more robotic surgeries than we did 40 years ago, or even 14 years ago. Sometimes that high-tech medicine leads to better outcomes, but a lot of the time it does not – it just means we spend more,” reckons an article in the Atlantic by specialists, who gave reasons for the increase health care cost across the global.
In Kenya, most of these big private hospitals have put Five-star luxury facilities to cater for the wealthy patients who are willing pay extra cash to ensure their comfort. The Nairobi’s Hospital’s North Wing and Aga Khan’s Princess Zahra Pavilion are rated as world class facilities.
At the popular North Wing, a night at the presidential suit costs Sh98,000, while at Princess Zahra Pavilion, the rates are between Sh34,100 and Sh43,700 per night. These rates compare favourably to charges per night at luxurious five-star hotels operating in Nairobi and Mombasa.