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Service Use, Charge, and Access to Mental Healthcare in a Private Kenyan Inpatient Setting: The Effects of Insurance

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  • Victoria Pattison de Menil
  • Martin Knapp
  • David McDaid
  • Frank Gitau Njenga

Abstract

The gap in Kenya between need and treatment for mental disorders is wide, and private providers are increasingly offering services, funded in part by private health insurance (PHI). Chiromo, a 30-bed psychiatric hospital in Nairobi, forms part of one of the largest private psychiatric providers in East Africa.The study evaluated the effects of insurance on service use and charge, questioning implications on access to care. Data derive from invoices for 455 sequential patients, including 12-month follow-up. Multi-linear and binary logistic regressions explored the effect of PHI on readmission, cumulative length of stay, and treatment charge.Patients were 66.4% male with a mean age of 36.8 years. Half were employed in the formal sector. 70% were admitted involuntarily. Diagnoses were: substance use disorder 31.6%; serious mental disorder 49.5%; common mental disorder 7%; comorbid 7%; other 4.9%. In addition to daily psychiatric consultations, two-thirds received individual counselling or group therapy; half received lab tests or scans; and 16.2% received ECT. Most took a psychiatric medicine. Half of those on antipsychotics were given only brands.Insurance paid in full for 28.8% of patients. Mean length of stay was 11.8 days and, in 12 months, 16.7 days (median 10.6). 22.2% were readmitted within 12 months. Patients with PHI stayed 36% longer than those paying out-of-pocket and had 2.5 times higher odds of readmission. Mean annual charge per patient was Int$ 4,262 (median Int$ 2,821). Insurers were charged 71% more than those paying out-of-pocket - driven by higher fees and longer stays.Chiromo delivers acute psychiatric care each year to approximately 450 people, to quality and human rights standards higher than its public counterpart, but at considerably higher cost. With more efficient delivery and wider insurance coverage, Chiromo might expand from its occupancy of 56.6% to reach a larger population in need.

Suggested Citation

  • Victoria Pattison de Menil & Martin Knapp & David McDaid & Frank Gitau Njenga, 2014. "Service Use, Charge, and Access to Mental Healthcare in a Private Kenyan Inpatient Setting: The Effects of Insurance," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-7, March.
    • Handle: RePEc:plo:pone00:0090297
    DOI: 10.1371/journal.pone.0090297
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    1. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    2. William C. Hsiao & R. Paul Shaw, 2007. "Social Health Insurance for Developing Nations," World Bank Publications - Books, The World Bank Group, number 6860.
    3. Jeff Barnes & Barbara O'Hanlon & Frank III Feeley & Kimberly McKeon & Nelson Gitonga & Caytie Decker, 2010. "Private Health Sector Assessment in Kenya," World Bank Publications - Books, The World Bank Group, number 5932.
    4. Araya, R. & Rojas, G. & Fritsch, R. & Frank, R. & Lewis, G., 2006. "Inequities in mental health care after health care system reform in Chile," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 109-113.
    5. Kara Hanson & Lucy Gilson & Catherine Goodman & Anne Mills & Richard Smith & Richard Feachem & Neelam Sekhri Feachem & Tracey Perez Koehlmoos & Heather Kinlaw, 2008. "Is Private Health Care the Answer to the Health Problems of the World's Poor?," PLOS Medicine, Public Library of Science, vol. 5(11), pages 1-5, November.
    6. Alexander S. Preker & Richard M. Sheffler & Alexander S. Preker, 2007. "Private Voluntary Health Insurance in Development : Friend or Foe?," World Bank Publications - Books, The World Bank Group, number 6641.
    7. Denis Drechsler & Johannes Jütting, 2005. "Is There a Role for Private Health Insurance in Developing Countries?," Discussion Papers of DIW Berlin 517, DIW Berlin, German Institute for Economic Research.
    8. World Bank, 2013. "Kenya Economic Update, December 2013, No. 9 : Reinvigorating Growth with a Dynamic Banking Sector," World Bank Publications - Reports 17002, The World Bank Group.
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