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

S. Mostert, F. Njuguna, P. M. van de Ven, G. Olbara, L. J P A Kemps, J. Musimbi, R. M. Strother, L. M. Aluoch, J. Skiles, N. G. Buziba, M. N. Sitaresmi, Rachel Vreeman, G. J L Kaspers

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: 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. Procedure: 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. Results: 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, P=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. Conclusions: 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.

Original languageEnglish
Pages (from-to)913-918
Number of pages6
JournalPediatric Blood and Cancer
Volume61
Issue number5
DOIs
StatePublished - 2014

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Kenya
Health Insurance
Insurance
Neoplasms
Insurance Coverage
Therapeutics
Health Status
Disease-Free Survival
Public Hospitals
Medical Records
Retrospective Studies
Odds Ratio

Keywords

  • Adherence
  • Childhood cancer
  • Health-insurance
  • Hospital retention
  • Low-income countries

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Mostert, S., Njuguna, F., van de Ven, P. M., Olbara, G., Kemps, L. J. P. A., Musimbi, J., ... Kaspers, G. J. L. (2014). Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatric Blood and Cancer, 61(5), 913-918. https://doi.org/10.1002/pbc.24896

Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. / 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, Rachel; Kaspers, G. J L.

In: Pediatric Blood and Cancer, Vol. 61, No. 5, 2014, p. 913-918.

Research output: Contribution to journalArticle

Mostert, S, Njuguna, F, van de Ven, PM, Olbara, G, Kemps, LJPA, Musimbi, J, Strother, RM, Aluoch, LM, Skiles, J, Buziba, NG, Sitaresmi, MN, Vreeman, R & Kaspers, GJL 2014, 'Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya', Pediatric Blood and Cancer, vol. 61, no. 5, pp. 913-918. https://doi.org/10.1002/pbc.24896
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, Rachel ; Kaspers, G. J L. / Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 5. pp. 913-918.
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abstract = "Background: 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. Procedure: 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. Results: 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, P=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. Conclusions: 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.",
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AU - Strother, R. M.

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AU - Skiles, J.

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N2 - Background: 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. Procedure: 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. Results: 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, P=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. Conclusions: 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.

AB - Background: 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. Procedure: 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. Results: 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, P=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. Conclusions: 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.

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