Influence of health-Insurance access and hospital retention policies on childhood cancer treatment in Kenya

Abstract

Background.Kenyan national policies for public hospitalsdictate that patients are retained on hospital wards until theirhospital bills are paid, but this payment process differs for patientswith or without access to National Hospital Insurance Fund (NHIF)at diagnosis. Whether these differences impact treatment outcomeshas not been described. Our study explores whether childhoodcancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies.Procedure.Thisstudy combined retrospective review of medical records with anillustrative case report. We identified children diagnosed withmalignancies at a large Kenyan academic hospital between 2007and 2009, their treatment outcomes, and health-insurance status atdiagnosis.Results.Between 2007 and 2009, 222 children werediagnosed with malignancies. Among 180 patients with docu-mented treatment outcome, 54% abandoned treatment, 22% hadtreatment-related death, 4% progressive/relapsed disease, and 19%event-free survival. Health-insurance status at diagnosis wasrecorded in 148 children: 23% had NHIF and 77% had no NHIF.For children whose families had NHIF compared with those who didnot, the relative risk for treatment abandonment relative to event-freesurvival was significantly smaller (relative-risk ratio¼0.31, 95%CI¼0.12–0.81,P¼0.016). The case report illustrates difficultiesthat Kenyan families might face when their child is diagnosed withcancer, has no NHIF, and is retained in hospital.Conclusions.Children with NHIF at diagnosis had significantly lower chance ofabandoning treatment and higher chance of survival. Childhoodcancer treatment outcomes could be improved by interventions thatprevent 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.