A controversial medical bill shared on social media from a private hospital evoked intense emotions from the public last week.
The charges of a patient admitted for emergency care following a stabbing, ended up being close to a million shillings for a day’s admission.
The discussions centered around the high cost of medical services in the private sector with little input regarding lack of similar services in public hospitals as a major reason why such events occur.
Private hospitals are caught up in a tussle between legal provisions on emergency care and ensuring financial operational requirements are met.
The matter was magnified by a law that states access to emergency care is a right. Sadly, the same legislation does not propose who should meet the hospital costs in such instances if a patient is unable to pay.
Emergency care as a component of medical services in hospitals are perhaps the most expensive, given the intensity and multiplicity of interventions in a relatively brief time.
On an hourly billing basis, intensive care, cardiothoracic and neuro-intensive interventions rank top drainers of patients’ and insurers bills.
A mismatch between costs and able payers has seen few public hospitals invest in resources and personnel to offer such services.
To put the matter into perspective, if you suffered a heart attack that necessitated intervention cardiology services between Mombasa and Nairobi, you most likely would not make it through that “golden hour” where intervention yields best outcomes. For neurosurgery or vascular surgery one would even fare worse given the low numbers.
A fundamental question arising from the debate is why such a distorted distribution in terms of skilled emergency medicine personnel and equipment exists.
Some would argue the lack of investment on such services in public facilities is a strategy to ensure as many as possible patients with other “cheap” conditions are served by the meagre resources.
From a hospital administrator’s viewpoint, delivery of such expensive services hinges on one model: prompt refills. Think of it as the only glass of water in a desert, with a “collection basket” next to it. The rule is: whoever empties it, must put a coin on the collection basket to allow a refill by the supplier for use by the following person.
At a workshop this week, it was highlighted that the government funded emergency fund envisaged to cater for such cases has no money. Thus handicapping hospitals keen to offer such services.
If the previous user did not place a coin, the next person will not pay because they will have no water to drink. A backlog ensues and it follows that the next person will miss water until such a time where one sacrifices to pay and foregoes his right to drink for a refill to occur.