Out-of-pocket costs for paediatric admissions in district hospitals in Kenya

Area of Science:

• Health Economics
• Pediatric Public Health
• Sub-Saharan African Healthcare Systems

Background:

• Kenya's policy aims to exempt children under 5 from user fees for inpatient care.
• District hospitals are crucial for providing pediatric healthcare in Kenya.
• Understanding out-of-pocket expenditures is vital for assessing healthcare access and equity.

Purpose of the Study:

• To quantify the out-of-pocket costs associated with inpatient pediatric care in Kenyan district hospitals.
• To identify the components of these costs and their distribution among caretakers.
• To evaluate the financial burden and equity implications of these expenditures.

Main Methods:

• Survey of 256 caretakers of children under 5 admitted to eight district hospitals across four Kenyan provinces.
• Data collection on care-seeking behavior and expenditures for inpatient care.
• Assessment of household socioeconomic status based on previous month's expenditure.

Main Results:

• 78% of caretakers incurred user charges, averaging US$8.1 (59% of total costs).
• Total mean out-of-pocket costs were US$14.1 per admission, with transport (36%) and medicines (5%) as other significant costs.
• 25.4% of caretakers faced catastrophic health expenditures, with a regressive burden on lower socioeconomic households.

Conclusions:

• Unofficial user fees persist in Kenyan district hospitals despite exemption policies for young children.
• High out-of-pocket costs create financial barriers to essential pediatric care.
• Development of financing mechanisms for financial risk protection is crucial to improve child survival rates.