Why Private hospitals require a working public health system

A booming private health care does not improve access. Nay. It signifies a dying public health sector. In his opinion article appearing in Business Daily on 25 September 2017, Dr Majid argues that prime private hospitals improve Kenyans’ access to healthcare, often to the chagrin of their financial returns.

He opposes National Health Insurance Fund (NHIF) move to make payments for their clients in stand-alone diagnostic centres; observing that this will curtail the only departments offering financial cushion to the private high-end hospitals.

While I would agree with Dr Majid that Kenya’s health statistics are dim across the demographic spectrum, I am at variance with his assertion that private hospitals improve patients’ access to care.
The surge in private facilities (plus any recent boom of patients in these facilities) is due to the near collapse of the public health. It is absence of service and consumables in public hospitals that drive Kenyans to the private ones, especially outside of the capital. Evidence tells us that the three top reasons for Kenyans choice of a health facility are the presence of qualified staff, proximity to their homes and availability of medicines. This is from the 2013 Kenya Household Health Expenditure and Utilisation Survey. This same survey indicates that only 20% of Kenyans, majority from the wealthiest citizens, seek admission into private hospitals. But even considering this rich club, 39.9% are admitted to public hospitals with 36.4% settling for the private ones.

I would like to loud Aga Khan and other private hospitals for upholding the constitutional rights of Kenyans and offering them emergency medical care irrespective of their financial ability. However, Dr Majid’s observation that private hospital critical care units run at losses should alert Kenyans to a statistic we like ignoring. That as doctors have consistently observed, majority of even the less than 5% of Kenyans who possess private health insurance cannot sustain an admission into a critical care unit in a Nairobi private hospital. That is not to mention those under NHIF. And as we found out from the 2014 Kenya Demographic and Health Survey, 8 out of 10 Kenyans lack health insurance.

In addition, these private health facilities do not cover the furthest corners of Kenya, often the nooks of the sickest. I guess that you won’t find an Aga Khan outreach centre in Elgeyo Marakwet, Baringo or Nyandarua counties. Nor might you find them in the depths of Samburu, Marasabit, Turkana or Tana River where less than 36 in 100 women deliver in hospitals. Even when available outside the major Kenyan towns, most of private health establishments depend on government doctors on part time locum basis.
At the height of the most recent doctors’ strike, a cabinet secretary publicly told Kenyans that the government was unwilling to pay doctors more as this would lead to collapse of the private hospitals. Thank God, he is not a doctor! For when a government official can put private business ahead of public health, only the doctor remains as the patient advocate in keeping with the ethics of medicine.
I work in a private health facility and I’m alive to the pain families will go through every day to raise that deposit for admission. And we know how many get lost to follow up once the pressing symptoms abate. Our national statistics show us that 12.7% of Kenyans experience catastrophic out of pocket health expenditure. And world estimates will put 65.7% of Kenyans as being at risk of catastrophic expenditure for surgical care compared to the world average of 44% and Rwanda’s (a smaller economy than Kenya) 57.6%. While Cuba has built 5.1 hospital beds per 1000 people, we have 1.4!

Private hospitals in Kenya have existed for long and a properly functioning public health sector will leave them room to play their rightful bridging role. Whether full private hospitals or private stand-alone diagnostic centres, the difference is the same. They fill in where the public health systems falls short.
A total collapse of the public health sector will only drive private hospitals into crises. Emergencies will fill these facilities to 110% occupancy. This strains the resources. This does not give room for the elective ‘centre-of-excellence’ care they would wish to offer. Quality might go down. We have learnt this from the recent and ongoing public health workers’ strikes. A proper functioning public health system will reduce the 3% of revenue for welfare and 2.5% written off as bad debts by Dr Majid’s institution. And the 200 patients treated for free and discharged would be reduced to 100 or fewer. And this can only be good for the private hospitals.

Evidence tells us that publicly funded healthcare ensures better population health at cheaper costs. Let NHIF cover public hospitals only. They can have amenity wings for civil servants. Those who wish to seek services from private hospitals when such are available in public ones should do so at their own cost. The infrastructure in the public health facilities across the country just needs an injection of monetary stimulus and better working ethos from the staff and Kenyans will be okay. We don’t need Kenyans rushed to private hospital emergency rooms only for them to be stranded begging for waiver after having spent their food budget on a couple of tests.

*This blog appeared as an article on the Business Daily on October 4, 2017