How hospitals rip off Covid-19 patients

One patient was charged for 84 face masks in a day, at Sh2,000 apiece.

In Summary

•The Ministry of Health says it is unable to regulate prices because most patients with severe Covid-19 are being treated for other underlying conditions as well. 

•Hospitalisation during the pandemic appears to add huge out-of-pocket costs to non-Covid patients in private hospitals in form of tests and PPE.

Some of the Covid-19 ICU beds.
CRITICAL CARE: Some of the Covid-19 ICU beds.

When the family of Laban Otieno studied the hospital bill for their 60-year-old father, they immediately noticed something amiss.

He was a diabetic patient who spent 10 days in the Intensive Care Unit of a private hospital in Nairobi where he died last month.

Before and during admission, Laban took the mandatory Covid-19 tests, which came out negative.

In the final Sh5 million bill, he was charged for daily personal protective equipment used by medical staff. The family said this was justified.

The severity of the Covid-19 outbreak in Kenya has forced many hospitals to make it mandatory for health workers to wear protective gear when attending to all admitted patients.

However, the breakdown of the 20-page bill showed as much as 10 units of full PPE a day at Sh4,000 each. On one day, he was billed for 84 different N95 masks, each at Sh2,000. 

"This was impossible, hospitals are just exploiting their patients and making a fortune out of their miseries in this national crisis," said Otieno's eldest daughter, July.

The bill was renegotiated but the family still feels cheated.

Hospitalisation during the pandemic appears to add huge out-of-pocket costs to non-Covid patients in private hospitals in form of tests and PPEs.

Similar costs are being imposed on Covid-19 patients. The Star saw one bill from a city facility where a Covid-19 patient was charged for eight different sets of PPEs in a day, at Sh3,500 a set.

He paid a bill of Sh1.8 million after eight days, six of them on a ventilator. A third of the bill was for PPEs.

The bills reveal significant variations in how patients are being charged, with PPEs accounting for s much as 60 per cent of some bills.  

While some hospitals are billing for as many as 10 PPE sa day, at Sh10,000 per set, others are using fewer and charging less per kit.

"It's a rip-off," says Reuben, who paid the Sh1.8 million and did not wish to use

"In isolation we were four patients in a room. A nurse would come five times in a day to bring food and pick utensils. Each of the patient was charged for the kits even though she would serve us all at the same time without changing. Then a doctor would come twice a day and a consultant once."

PPEs include full body suits, gloves, masks, goggles, face shields , respirators, show covers and head covers, among other items.

It is unlikely they are disposed of after every visit because that would amount to huge unnecessary medical waste and the supply is limited.

"If it is true that every doctor in Kenya’s public health system is required to visit patients several times a day and all staff are required to change into new PPEs with every attendance, then this is luxurious attendance that is wasting acutely needed resources," says Kwame Owino, CEO of the Institute of Economic Affairs, a Nairobi-based think tank on public affairs.

The MoH guidelines on Covid-19 treatment do not say if medics should change PPEs for each visit and what the basic or upper price should be per kit.

However, the Kenya Medical Research Institute-Wellcome Trust has published a policy brief to guide prices for Covid-19 treatment.

The brief says costs range from Sh21,359 per day for asymptomatic patients, Sh21,361 per day for patients with mild symptoms, Sh24,705 for patients with severe disease and Sh51,684 for critical patients in ICUs.

Kemri-Wellcome Trust Nairobi director Edwine Barasa and Dr Angela Kairu, who developed the brief last month, say PPEs' cost accounts for approximately 65 per cent of the total cost.

For instance, a patient with a severe case would pay Sh296,465 for a 14-day hospitalisation, most of it being the cost of PPEs - Sh187, 236.

However, some facilities are charging even 10 times this amount.

"If these costs are passed on to patients to pay out of pocket, they will result in significant catastrophe and impoverishment," Barasa and Kairu say.

These costs are also being pushed to non-Covid-19 patients.

Insurers are unwilling to cover the costs of tests and PPEs for  non-Covid patients. 

For Covid-19 patients, most private insurers do not pay anything, while the National Hospital Insurance Fund only pays for treatment in public hospitals.

The Ministry of Health says it is unable to regulate prices because most patients with severe Covid-19 are being treated for other underlying conditions as well. 

“You find that the patients end up with multiple organ problems leading to multiple organ failure so when the lungs begin to fail, the kidneys also slow down, the heart slows down and you will be required to support all these organs," acting director general Patrick Amoth said.

“For kidneys, you will be required to do hemodialysis to remove the toxins; for the heart you need to give them medicines for them to maintain good blood pressure for continued circulation. All these are very complicated procedures and processes which take a lot of time of healthcare workers.”

Wang’ombe Kariuki, director general of the Competition Authority of Kenya, is against capping the prices of PPE.

"The Covid-19 pandemic has seen some countries revert to price controls. As competition agencies, we need to advise our governments that price controls are counterproductive since they ultimately harm consumers, more so by facilitating proliferation of black markets. Quality and safety of goods is also not guaranteed," he said. 

The Kenya Association of Private Hospitals defends private facilities saying their costs are based on market forces. 

KAPH secretary general Dr Abdi Mohammed said costs also depend on the status of hospitals. 

"It is like hotels. Hilton will definitely charge differently compared to a smaller hotel downtown, because of the clientele they attract. So it is important to check the costs before deciding which hospital to seek services from," he told the Star.

Edited by Henry Makori