Around the country, pressure is rising to rein in the cost of health care and more Kenyans are starting to recognize the inefficiency of the private insurance system. A health-care system exists primarily for the benefit of patients, but their voices are so rarely heard.
What attracts people to private healthcare is poor public health service. The hope of choosing your own doctor and hospital facilities, shorter wait times for hospital procedures, and perceived quality of care and “peace of mind” when one needs health services. But the peace of mind that private health insurance is supposed to bring is very illusionary. Often, it’s the shock of unexpected out of pocket expenses and the realization that certain procedures are not covered. Moreover, insurance companies constantly change their policies making it difficult for even astute consumers to asses the true cost and value of their private health insurance. In fact, many people know little about the policy they buy, what and how much it covers or, whether it is good value and suitable. Insurance companies carefully craft their policies to exploit the ignorance of many.
Because health care markets are monopolistic, prices for medical procedures are not made public and vary enormously across the providers. Insurers don’t always do what is right, and if you talk to Kenyans with serious illnesses, you’ll hear plenty of horror stories.
Insurance companies have a financial incentive to deny needed medical coverage because what they spend on health care is “medical loss” because it leaves less money for their shareholders and CEOs. Usually, the expenses fall on specialized services and non-prescription medicine. These are uncapped, meaning the consumer is left bearing all open-ended risk. People ending up in hospitals as in-patients for diabetes and other conditions that should be treatable or manageable out of hospital is a warning sign of system failure. In short, private insurance, encourages over-servicing and cost escalation. It is an expensive way to fund health care. We need a working National Health Care Service, funded by all and available to all Kenyans according to their medical needs, regardless of income.
The increase in services delivered in private hospitals will not ease the pressure on public hospitals as government hopes. In fact, waiting times for urgent procedures in public hospitals has increased and so is the number of patients waiting their turn. As our population ages,the more we will have to spend on healthcare. Government must do more to deliver a sustainable healthcare suitable for all not just to attract voters, but to meet the health needs of all. Real reforms will require time frames well beyond those of the election cycle. The well-being of Kenyans requires a health-in-all policy approach in all government portfolios. This is a matter of leadership and cultural change, not new expenditures and regulations.