Business of medicine: Coughs, colds gobble up millions from insurers

Sunday February 11 2018

Respiratory diseases have topped Kenyans’

Respiratory diseases have topped Kenyans’ insurance claims over the past three years.  

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Lifestyle changes, characterised by poor diet, alcoholism and reduced physical activity, are driving up Kenya’s cost of health care.

Respiratory diseases like influenza, asthma, the common cold, flu and coughs have been topping insurance claims over the past three years.

Data from Kenyan medical insurance providers shows that in 2016, the top 11 firms paid out more than $36.1 million in claims for respiratory diseases, up from $23.5 million the previous year. About 40 per cent of the payouts was for antibiotics.

A total of $74.01 million was paid out in medical claims in 2016, up from $63.25 million the previous year.

“The highest number of visits to hospitals is always for upper respiratory infections, which include throat infections like tonsillitis, and common colds. They are the ones burdening the country’s healthcare,” said Dr Elijah Matolothe, the head of provider partnerships and medical business at Jubilee Insurance.

Last week, the Kenya National Bureau of Statistics (KNBS) released data that showed respiratory disorders were the leading cause of ailments, especially in children below the age of five. According to the data, more than 4.1 million cases of respiratory disease were reported among children.

The country’s hospitals also handled 613,777 pneumonia cases and 85,890 asthma cases. Some 3.5 million cases of other diseases of the respiratory system, including tuberculosis and influenza, were recorded.

“From our end we see a lot of the inpatient admission over these respiratory ailments being children who are largely affected by pneumonia, whose cost of treatment is high,” Dr Matolo said.

Burden of NCDs

The data from KNBS also showed that for malaria and diarrhoeal diseases 1.59 million and 1.47 million cases were reported at health facilities, respectively. More than 492,000 hospital visits were recorded for respiratory disorders for both the inpatient and outpatient visits in 2016, up from 417,000 visits in 2015.

On average, Kenyans spent $43.89 per outpatient visit, up from $38.59 in 2015. The inpatient costs for the treatment of respiratory disease rose by 12 per cent, to $944.8 per visit from $846.14 per visit in 2015.

“We have seen a rise in the non-communicable diseases (NCDs) in the country, including hypertension, diabetes, respiratory and oncology diseases. We have been working on the data, which will assist us in obtaining funding to tackle and eradicate this issue,” said Dr Ephantus Maree, deputy director of medical services and head of the non-communicable diseases unit at Kenya’s Ministry of Health.

Risk factors

Christina Perez, the capacity development director at the East African NCD Alliance said regional governments should take decisive action in preventing and treating non-communicable diseases.

“Regional governments need to integrate them in different development plans for better prevention and treatment. For instance, taxing unhealthy commodities such as alcohol, tobacco, unhealthy foods and drinks, and the allocation of taxes to the prevention, management and control of NCDs as well making sure that people with NCDs get access to the needed care,” Ms Perez said.

The Global Burden of Disease 2016 report showed that respiratory diseases, HIV/Aids and malaria were the major causes of early death in in the region in both children and adults.

“The three risk factors that account for the most disease burden in the region are lifestyle choices, alcohol use, air pollution from solid fuels, and poor exercise regimes. In terms of prevention, we need to more education as some of these respiratory ailments are self-healing or could be managed via home remedies. We shouldn’t spend millions of dollars as a country treating viral infections yet we have serious healthcare needs,” Dr Matolo said.

Other diseases that have seen a rise in insurance costs include cancer, at $5.14 million on inpatient costs in 2016 from $4.3 million the previous year. The cost of diseases of the digestive system rose to $7.3 million in 2016, up from $6.13 million the previous year. The cost of treating malaria and HIV/Aids fell to $2.1 million from $2.6 million, and $1.4 million from $1.1 million, respectively.

Create awareness

The 2016 Institute for Health Metrics and Evaluation report indicates that the increase of non-communicable diseases and related risks factors may reverse Kenya’s recent gains in health.

“The increased burden of these ailments if remain unchecked, will have far-reaching socioeconomic effects in Kenya that span from the household to the health system. The increasing higher rates of health loss can be attributed to risk factors such as poor diet, hypertension, high fasting blood glucose, high cholesterol, and physical inactivity,” the report states.

Last month, the World Health Organisation (WHO) said that the burden of non-communicable diseases, which has been gradually increasing over the past decade, will likely surpass the toll of sickness and death from infectious diseases in Africa by 2030.

“These life threatening diseases are robbing people and families of those who otherwise should be enjoying their most productive years and place a significant hardship on the region,” WHO regional director for Africa Matshidiso Moeti said.

At the non-communicable diseases conference in Rwanda last week, the country’s health minister Dr Diane Gashumba said there was a need to create awareness on healthy lifestyles.

“We need to do more sensitisation for our people because lifestyle choices are the main cause of respiratory diseases, including eating sugary products, tobacco use, excess oil and beer,” Dr Gashumba said adding that the Health Ministry has partnered with the Education Ministry to raise awareness amongst children.

Rwanda has introduced programmes such as the car-free-day, in which people engage in sports across the country twice a month.