A government investigation of 12 top hospitals has exposed the agony that patients and families unable to pay medical bills go through to secure freedom after discharge.
A report of a special team set up by the Health Ministry shows that some hospital mortuaries are stretched, a situation worsened by abandoned bodies and those whose families cannot pay up for their release.
So bad is the situation that at the Kenyatta National Hospital (KNH) morgue, there are 387 bodies, 261 more than its capacity.
The report shows that 445 patients had been found unable to pay up at KNH by February this year, with bills totalling to Sh60 million.
Streamline the operations
Interviews with top ministry officials last week revealed that they plan to use the findings of the report to mount a campaign to ease the burden.
Health Cabinet Secretary Sicily Kariuki is reportedly preparing to roll out reforms to streamline operations in public hospitals.
“The CS is very determined to restore order in the affected public facilities and is ready to do whatever it takes to address the crisis,” the source said.
The report of a special team appointed to investigate detention of discharged patients in hospitals and bodies in mortuaries due to uncleared bills seen by Sunday Standard notes that the ministry has been receiving public complaints over detention of patients and bodies.
The report says there were 250 patients discharged but still held at KNH by April 1 over inability to pay bills.
The hospital also was detaining seven bodies over outstanding bills. “Every ward has a room that keeps discharged patients and mothers with pre-terms in newborn unit,” the report says of KNH.
At the Nairobi Women’s Hospital, 15 bodies were held over outstanding bills with 12 discharged patients withheld over the same. Some 103 patients who had been discharged were yet to be released at the Mathari National Teaching and Referral Hospital.
The team, appointed by Principal Secretary Susan Mochache on March 26, was tasked to conduct investigation to determine procedures for patient discharge, payment and release from hospitals.
It was also to put mechanisms and policies in place to deal with emergency admissions and patients who are unable to meet their bills at the time of discharge.
Ms Mochache also asked the team to find out the number of patients/mothers who have been discharged but retained in hospitals.
According to the team, only four patients had stayed at the Eldoret-based Moi Teaching and Referral Hospital, awaiting waiver processing.
Delays in submission
They recommend that the government compensates institutions that provide emergency health care to persons who cannot pay. “This may take the form of an emergency services fund which can be used to reimburse expenses to hospitals that render services,” the report says.
It also recommends that the funds allocated to the health sector be raised to 15 per cent of Gross National Product in line the “Abuja Declaration” to address the rising needs in the sector.
The report also faults the National Hospital Insurance Funds’ management of claims, proposing that the institution makes the process of notifying patients of their hospital admissions more flexible.
NHIF should also handle cases where there are delays in submission of documents.
The team recommends setting up of a fund that will be used to compensate institutions that provide emergency healthcare to persons who cannot pay.
More than 300 needy patients were allowed to go home from KNH in March following a public outcry over unsettled bills.
KNH has accrued losses of Sh900 million since the start of the financial year that began in June 2018 over unpaid bills.
To further caution health facilities from more pending bills, the Ministry of Health wants NHIF to improve its responsiveness in respect of authorisations for treatment and reimbursement of claims.
“In some hospitals, it was found that NHIF declined to take responsibility if notifications are not made within 24 hours,” according to the report.
Among other recommendations by the special team is a strategic partnership between the Health Ministry and Social Services Department under the universal health coverage programme to ensure most vulnerable citizens have access to quality healthcare without being crippled by financial hardships.
“The ministry should consider partnering with Social Services department and other stakeholders to offer a package of health and social services for abandoned patients,” the team recommended.
There should be a policy to guide interaction of mothers and their preterm babies receiving care in newborn units.
“The policy should tackle options for accommodation for mothers and security of the babies borrowing from best practice in some private hospitals such as Nairobi, Mater and Aga Khan,” the report says.
It also recommends that each county be encouraged to construct mortuaries to decongest those in level 6 hospitals.
The report suggests that each county builds at least one public mortuary.
Health Laws Amendment Bill (2018) sponsored by Nyando MP Jared Okello seeking to outlaw detention of patients is pending in Parliament. The Bill proposes stiff penalties for hospitals found detaining patients or corpses over unpaid bills.
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