Unmasking an ailing health care system

The right to health is guaranteed in the Constitution. Health is one of the functions that was devolved under the new dispensation.

The shift from national to county governments has taken resources closer to the people. However, challenges continue to plague this important sector.

The United Nations SDGs put into perspective the need for universal health care, which envisions an organised system that can provide benefits that are accessible to all persons.

HEALTH CARE

This entails access to quality essential health care and safe, effective and affordable medicines and vaccines for all.

It provides a paradigm shift towards looking at health care in its totality rather than the silo analysis that leads to inappropriate decisions.

The achievement of Universal Health Coverage can have far-reaching effects on the wellbeing of a nation.

Low insurance coverage often complicates issues as only four per cent of Kenyans can access it. When looking at the cost of health care, it is often easy to focus on the cost of commodities, which includes aspects such as nursing, laboratory expenses, hospitalisation and bed charges, and consultation fees.

There are a host of “invisible” costs, such as transport that are borne by patients which can prevent or delay access to care.

Debate about the use of generics as opposed to the branded products elicits a one-sided argument that often mixes issues but misses key concerns. Going by treatment volumes the world over, the cost and coverage of generic drugs far exceeds that of original products.

In Kenya, patented drugs account for nine per cent of the total drugs sales and only 13 per cent of consolidated prescription drug sales, the rest being generic products. As such, disproportionate attention and efforts focusing at only the cost of innovator products will yield to very small savings to the health care system.

SUBSTANDARD

The rationale for use of innovator products is misunderstood not only by patients but unfortunately by some health care providers, too. While generics are a true copy of the innovator products by virtue of sharing the same active ingredient, the two are never 100 per cent the same.

While generic products are not fake as is irresponsibly connoted, there are substandard medicines that present the greatest challenge. Sadly, there’s a consistent misconception that cost of treatment and the cost of medicine mean one and the same thing.

Looking at health insurance coverage, it is important to note that the current insured pool of four per cent is too small to make any insurance business case by way of pooled risk.

This often leaves the insurers exposed to undue payment pressures. Perhaps the way out would be not only to expand the coverage base, but also increase the services.

This way, we can build towards a critical mass for pooled risk that makes an attractive business case for the insurers.

As such, the solution lies in better pooling of risk rather than isolating cost line items from insurance providers for elimination.

This would actually work against the whole idea of expanding the coverage base.

By these examples alone, it is possible to see how misleading it can be to make an analysis of costs by just looking at one aspect of the health care system.

Therefore, more efforts need to be put in by the stakeholders, including the patients; to 1) fully understand and own the system, 2) advocate more funding for health care 3) advocate and safeguard the proper apportioning and use of resources 4) attain and sustain effective and responsive drugs regulation, and, 5) increase insurance coverage.

Dr Mwatu is an executive committee member at the Kenya Association of Pharmaceutical Industry (Kapi). [email protected]