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Home-based Covid-19 care cuts costs 70pc

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A health worker checks up on a patient under the home-based care system. PHOTO | SHUTTERSTOCK

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Summary

  • The government last year rolled out home-based care for Covid-19’s asymptomatic patients to cut huge hospitalisation bills as well as ease pressure on isolation centers and hospitals.
  • For this to happen, patients were to present asymptomatic or mild-to-moderate symptoms, comorbidities absence and access to a suitable space for home-based isolation.
  • Since the policy was introduced, Kenyans have been spared huge medical bills they would have otherewise paid in hospitals and isolation centers managements.

The government last year rolled out home-based care for Covid-19’s asymptomatic patients to cut huge hospitalisation bills as well as ease pressure on isolation centers and hospitals.

For this to happen, patients were to present asymptomatic or mild-to-moderate symptoms, comorbidities absence and access to a suitable space for home-based isolation.

"About 78 percent of our patients are asymptomatic or have mild symptoms, which enables us to implement the home-based care system since they can comfortably be taken care of at home," Health Chief Administrative Secretary Mercy Mwangangi said last year.

They are required to self-isolate at homes, schools and hotels as well self-declare symptoms daily to a healthcare provider using a mobile phone application.

For severe symptoms, however, patients are transferred to hospitals.

Since the policy was introduced, Kenyans have been spared huge medical bills they would have otherewise paid in hospitals and isolation centers managements.

While asymptomatic patients do not incur costs such as pharmaceuticals, they incur charges such as hotels, staff time costs for monitoring, personal protective equipment (PPE) and laboratory costs for diagnosis.

A new study published on BMJ Global Health-a global medical journal-titled Examining unit costs for Covid-19 case management in Kenya’ shows that Covid-19 unit cost for a single asymptomatic patient with mild-to-moderate at home based care facility is 70 percent cheaper than in hospital and isolation centers.

Whereas it costs Sh23,942, hospital and isolation centres per case management of Covid-19 is Sh80,638.86.

Expenses coming from tests, radiology, personal protective equipment (PPE), pharmaceutical (medicine) and non-pharmaceuticals (such as fluid and devices).

“Unit costs under home-based care are substantially lower than unit costs for institutional care (hospitals or isolation centres). This is because home-based care avoids hospital accommodation and overhead costs and is characterised by minimal health worker–patient physical interactions, and hence saves on staffing, accommodation and PPE costs,” the study, whose data were provided by three public Covid-19 treatment hospitals in Kenya, notes.

As a result, footfalls at hospitals and isolation centres declined, ensuring better healthcare to patients.

For severe to critical infections in isolation centres and hospitals, cost per head is 79.2 percent higher than home based care systems.

For example, Sh758,917.30 is needed for critical management which on average costs Sh157, 644.79 under home based care.

In January, the Central Bank of Kenya (CBK) statistics showed that health inflation hit an all-time high of 3.04 percent, signalling high cost of medicines, among others, at a time when Kenyans were jobless.

Patients with critical disease incur higher intensive care-related costs that include specialist staff (critical care physicians, anaesthetists) and more staff time per patient, pharmaceuticals (antibiotics and anaesthesia medicine) and non-pharmaceuticals (total parenteral nutrition), mechanical ventilation and other monitoring equipment costs, the study notes.

“Reducing the cost of PPE by 30 percent cuts the cost of care by between eight percent for severe disease managed at home and 46 percent for critical care,” the study notes.

This came at a time when insurance companies were paying millions of shillings in claims, highlighting the toll the pandemic is taking on the finances of the insurance sector.

As at April 21, for instance, Minet Kenya had paid Sh302.5 million for Covid-19 related claims emanating from PPEs, doctors’ fees, and bed charges, depending on admission.

“This is from a reported 895 cases within the various medical schemes we manage,” the company said in a statement last week.

Out of these, 737 have been discharged, fatalities (94) while those still in hospitals (63).

“The average cost of treatment is around Sh330,000.”

Last year, the firm’s chief executive officer Sammy Muthui attributed the high costs on ICU-related cases as well as PPEs charges.

The Insurance Regulatory Authority (IRA) last year instructed all firms to settle medical and life claims arising from the infections after the country reported its first case in March.

Cost-effective interventions

Insurers, however, were divided on covering the claims after the pronouncement of coronavirus as a pandemic, which is excluded from insurance policies.

“Insurers are now more careful on how they word their contracts and including clauses on pandemics and epidemics to avoid disappointing customers,” Godfrey Kiptum, IRA chief executive, said.

Data from IRA showed that companies’ annual insurance payments for death, injury and disability covers fell 12 percent to Sh9.71 billion, the lowest level in six years, driven by job cuts that followed the coronavirus pandemic.

"For instance, when compared with the average claims value (Sh40,000) reported by Kenya’s national health insurer, the NHIF, hospital management of asymptomatic and mild -to-moderate Covid-19 is two times higher while that for severe disease is four times higher," the study adds.

However, not all Kenyan are insured, exposing millions to financial burdens of managing the virus.

A different study conducted by Infotrak Research and Consulting in 2019, showed that 51 percent of Kenyans do not have a medical insurance cover while 49 percent have some sort of cover.

“To effectively respond to the pandemic, countries need to identify cost-effective interventions, plan and mobilise resources to deploy these interventions in ways that enhance health system goals that include equitable access, efficiency, quality and financial risk protection,” the report noted.