Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.

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 E...

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Autores principales:	Victoria Pattison de Menil, Martin Knapp, David McDaid, Frank Gitau Njenga
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/021a7a6de0304050a617b7cdf518ccf5
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spelling	oai:doaj.org-article:021a7a6de0304050a617b7cdf518ccf52021-11-18T08:27:10ZService use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.1932-620310.1371/journal.pone.0090297https://doaj.org/article/021a7a6de0304050a617b7cdf518ccf52014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24651115/?tool=EBIhttps://doaj.org/toc/1932-6203The 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.Victoria Pattison de MenilMartin KnappDavid McDaidFrank Gitau NjengaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e90297 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Victoria Pattison de Menil Martin Knapp David McDaid Frank Gitau Njenga Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
description	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.
format	article
author	Victoria Pattison de Menil Martin Knapp David McDaid Frank Gitau Njenga
author_facet	Victoria Pattison de Menil Martin Knapp David McDaid Frank Gitau Njenga
author_sort	Victoria Pattison de Menil
title	Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
title_short	Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
title_full	Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
title_fullStr	Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
title_full_unstemmed	Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance.
title_sort	service use, charge, and access to mental healthcare in a private kenyan inpatient setting: the effects of insurance.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/021a7a6de0304050a617b7cdf518ccf5
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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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