Patient costs of diabetes mellitus care in public health care facilities in Kenya.

Robinson Oyando,Edwine Barasa,Martin Njoroge,Kenneth Munge,Andrew Obala,Antipa Sigilai,Jane Mbui,Anthony Etyang,Zipporah Bukania,Peter Nguhiu,Fredrick Kirui

doi:10.1002/hpm.2905

Abstract

SummaryObjectiveTo estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya.MethodsWe conducted a cross‐sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care‐seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost‐of‐illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non–health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients.ResultsMore than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4‐64 188.6) (US$ 528.5 [95% CI, 427.7‐629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910‐25 438.8) (US$ 227.2 [95% CI, 205‐249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes‐only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7‐70.7) and increased to 75.4% (95% CI, 68.3‐82.1) when transport costs were included.ConclusionThere are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

Highlights

Diabetes mellitus (DM) is a chronic, incurable, and potentially disabling disease that presents a substantial public health challenge worldwide.[1]
Male Female Illness condition Diabetes mellitus Diabetes mellitus & Hypertension Enrolled to a health insurance scheme Yes No Employment status Formal employment Informal/unemployed Reason for not working Related to DM/DM & HTN comorbidity Not related to DM/DM & HTN comorbidity Highest level of education None Primary Secondary Graduate/certificate Where diagnosed Public facility Mission facility Private facility Illness duration 6 mo to
Medicines attracted the highest cost in the overall sample, mean annual cost Kenya shillings (KES) 10 159.2 (US$ 99.6 [95% confidence intervals (CI), 70.3‐128.9]), and in the comorbid patients, mean annual cost KES 12 839.2 (US$ 125.9 [95% CI, 78.1‐173.6])

Summary

Introduction

Diabetes mellitus (DM) is a chronic, incurable, and potentially disabling disease that presents a substantial public health challenge worldwide.[1]. Diabetes care is typically offered through dedicated specialized clinics located in public levels 4 to 6 hospitals.[11,12,13,14] In some areas, patients can access medication from health centres and dispensaries, but this is the exception rather than the norm. Each of these levels are expected to provide some aspects of preventive, promotive, curative, and rehabilitative services as outlined in the Kenya Essential Package for Health,[15] which includes interventions and services targeted at DM. Kenya's health system is financed by (a) tax revenues collected by the government (national and county), (b) donor funding, (c) household contributions to the National Hospital Insurance Fund (NHIF), (d) household contributions to private health insurance companies, and (d) out‐of‐pocket (OOP) payments at points of care

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