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

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

doi:10.1002/hpm.2752

Abstract

SummaryBackgroundHypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya.MethodsWe conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients.ResultsOverall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7‐71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8‐190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8‐50.2) and increased to 59.0% (95% CI, 52.2‐65.4) when transport costs were included.ConclusionsHypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.

Highlights

High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care
Male Female Highest education level None Primary Secondary Higher Enrolled to a health insurance scheme Yes No Employment status Formal employment Informal/unemployed Breadwinner Patient Not patient Reason for not working Related to hypertension Not related to hypertension Where diagnosed Public facility Private facility Illness duration 6 mo‐1 y 1‐5 y >5 y (n) Observations 212 (212) 50 (212) 162 (212) 61 (212) 82 (212) 53 (212) 16 (212) 46 (212) 166 (211) 42 (211) 169 (211) 94 (211) 117 (208) 46 (208) 162 (212) 186 (212) 26 (212) 33 (212) 101 (212) 78
The mean annual direct cost for seeking diagnostic or laboratory test services was US$ 31.8 with transport costs accounting for 74.2% of total of‐pocket payments (OOP) costs (Table 3)

Summary

Introduction

3 The double burden of communicable and noncommunicable diseases (NCDs) in many low‐ and middle‐income countries (LMICs) places an additional burden on the already constrained health resources and is a threat to the attainment of UHC goals.[4,5,6,7]. Kenya is committed towards attaining UHC by 2022.8 The Kenyan health sector is funded by different sources[9] including; the government, out‐of‐pocket payments (OOP) and donors.[10,11,12,13,14] The high level of OOP payments increases the risk of catastrophic health expenditure where households spend a large proportion of their budget on health care, which have negative implications on living standards as they forego other goods and services.[15] The incidence of catastrophic health care expenditure (at the 40% of annual non‐food expenditure threshold) related to direct health care payments to providers in Kenya is estimated to be 4.52%.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]

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