Private hospitals have nearly doubled maternity charges in the past eight years in a move that has effectively countered government efforts to improve the safety of mothers and new-borns with the removal of barriers to primary healthcare such as user fees.
Charges for both normal and Caesarean-section (C-section) deliveries rose by 90 per cent in major hospitals such as Nairobi Hospital, Karen Hospital and Nairobi Women’s Hospital, turning them into exclusive facilities for the deep-pocketed.
Health secretary Cleopa Mailu, who was until recently the chief executive at Nairobi Hospital, reckons that the fee increases are related to the provision of premium services that are not available in public hospitals.
“My experience is that investors are now leaning towards creating a hotel-like level of comfort for patients that take in heavy investment and maintenance costs,” Dr Mailu said.
The fees have nearly doubled in hospitals like MP Shah where normal delivery currently costs Sh130,000 compared to Sh70,000 in 2008. The hospital now charges Sh260,000 for a C-section delivery up from Sh135,000 in 2008.
Nairobi Hospital’s charges are up from Sh55,000 to Sh98,000 for anormal delivery while a C-section currently costs Sh220,000, up from Sh155,000 eight years ago. In that period, Nairobi Women’s Hospital increased its normal delivery charges from Sh45,000 to Sh64,000 while a C-section now costs Sh145,000 from Sh99,000.
Among the facilities sampled, Avenue Hospital has the lowest charges of Sh24,000 for normal delivery and Sh65,000 for a C-section.
State-owned Kenyatta National Hospital’s (KNH) private wing has not spared its patients the user fees inflation and is currently charging Sh53,000 for normal delivery and Sh152,000 for C-section.
The full impact of this user fee inflation is that households must dig deeper to finance childbirth even as they continue to pay more in taxes and for other goods and services.
The extent of this user fee inflation is underlined by the fact that most rates now stand above the average insurance cover limits, forcing patients to top up in cash for the excess charges.
Besides, there is little help from the National Hospital insurance Fund (NHIF), which has capped its normal delivery provision at Sh10,000 and Sh30,000 for C-section.
On average, the block charges cover three days of hospital stay for normal deliveries and five days for C-section. Any extra days spent in hospital thereafter must be paid for separately.
Insurance companies, which foot much of the healthcare costs, described the fee increases as exorbitant pointing to their fixing above the annual inflation rates.
Hospitals insist that the fee increases are mainly driven by the continued rise in the cost of living (inflation), the cost of doing business, power, water, rent and imported medical equipment and drugs.
Lydia Kibaara-Nzomo, the managing director of Saham Assurance, said the heavy burden that service charge inflation has imposed on underwriters is forcing them to negotiate price agreements with each hospital to remain in business.
“We have to agree on a rate that each hospital will be charging in order to stay afloat,” she said.
The insurance industry’s position has been made harder by the fact that more women are choosing to deliver through the more expensive caesarean section leaving them with heavy charges to settle.
Dr Mailu said a significant proportion of the maternity charges could be avoided pointing to the fact that the majority of women who undergo elective C-section are fit for normal delivery.
“There is an increasing number of women opting for C-section and accessing the same when there are no clinical conditions requiring the same. This is mainly common in the private sector,” said Dr Mailu.
Ms Kibaara-Nzomo said there has been a steep increase in the number of procedures being performed on maternity patients, which ultimately result in cost inflation.
The increasing burden of medical charges piles more pressure on insurers who have been reporting losses for years. Medical insurance accounts for a quarter of the general insurance business.
The Association of Kenya Insurers (AKI) says in its 2014 annual report that medical insurance collected Sh25 billion in premiums but made an underwriting loss of Sh90 million mainly hobbled by fraudulent claims and inflation of charges.
AKI chief executive Tom Gichuhi said the report did not isolate data for maternity charges but added that the cost of medical care, from consultation to bed charges, has been on the increase.
The higher maternity fees mean that more mothers may be pushed out of the top-of-the-range medical facilities and made to battle it out for space and attention in the less costly hospitals.
Dr Mailu said that the government’s decision to introduce free maternity services has improved the number of hospital deliveries from 600,000 to 1.2 million mothers, meaning it has help fix the bottom end of the market.
“This means homebirths are reducing and with it the risks to mothers and new-borns lives,” he added.