Influence of health‐insurance access and hospital retention policies on childhood cancer treatment in Kenya. Issue 5 (17th December 2013)

• Record Type: Journal Article
• Authors: Mostert, S.; Njuguna, F.; van de Ven, P.M.; Olbara, G.; Kemps, L.J.P.A.; Musimbi, J.; Strother, R.M.; Aluoch, L.M.; Skiles, J.; Buziba, N.G.; Sitaresmi, M.N.; Vreeman, R.C.; Kaspers, G.J.L.
• Is Part Of: Pediatric blood & cancer. Volume 61:Issue 5(2014:May)
• Page Start: 913
• Page End: 918
• Publication Date: 2013-12-17
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24896
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pbc24896-sec-0001" sec-type="section"> <title>Background</title> <p>Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health‐insurance status and hospital retention policies.</p> </sec> <sec id="pbc24896-sec-0002" sec-type="section"> <title>Procedure</title> <p>This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health‐insurance status at diagnosis.</p> </sec> <sec id="pbc24896-sec-0003" sec-type="section"> <title>Results</title> <p>Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment‐related death, 4% progressive/relapsed disease, and 19% event‐free survival. Health‐insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event‐free survival was significantly smaller (relative‐risk ratio = 0.31, 95% CI = 0.12–0.81, <italic>P</italic> = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital.</p> </sec> <sec id="pbc24896-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop. Pediatr Blood Cancer 2014;61:913–918. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>