Reducing doctors’ fees has no effect on Universal Health Coverage policy

What you need to know:

  • The standardisation of doctor’s fee capping both the minimum and the maximum that doctors in private practice charge already exists in the law.

  • All doctors, like all Kenyans, support the Universal Health Coverage programme.

  • It should be implemented. However, interfering with private hospitals and private medical practitioners will not facilitate what remains a public sector programme.

Brian Taraji is an adventurous, alert and energetic two-year-old. A fortnight ago, Taraji swallowed a groundnut he had picked under the carpet. A period of silence, a persistent cough and a moment of gasping alerted his mother, Jayne Penda, that the two-year old had developed a problem. A doctor’s consultation and an x-ray showed that the nut was lodged in his chest and it was removed in a 45-minute endoscopic operation that did not require any cuts on Taraji.

Taraji received timely treatment chaperoned by adequate health resources including a specialised medical team with appropriate equipment. It would have been a different script if the Ear Nose and Throat specialist did not have a well-equipped theatre and a surgical team to save his life.

PRIVATE PATIENTS

A proposal by Parliament to cut medical fees and charges is premature and will not contribute to the attainment of Universal Health Coverage. The standardisation of doctor’s fee capping both the minimum and the maximum that doctors in private practice charge already exists in the law and is governed by Section 23 of the Medical Practitioners and Dentists Act, Cap 253. In public and government run medical facilities, the government employed doctors work like all the other employees there and do not charge any fees at all, except for private patients.

What should be crystal clear is that the roll out of Universal Health Coverage, which in essence is government paid for healthcare that is offered free to the public, begins and remains confined to the government-run health facilities. This in itself is not new in Kenya and existed during the Mzee Jomo Kenyatta and part of the Daniel Arap Moi administrations until the structural adjustment programmes of the IMF demanded that the government introduced cost sharing in healthcare. Implementing the UHC is itself as simple as it was for the Mwai Kibaki Administration to introduce Free Primary Education. All that is requires is a decision on the part of the national government in consultation with the county governments, to decide and roll it out. No one and no sector of society is opposed to this.

BOTTLENECKS

Since these governments already pay for the health workers, the medical and pharmaceutical supplies as well as other related costs, the decision is not a difficult one. There are pilot UHC programs running in four counties with the aim of identifying any bottlenecks ahead of rolling out the programme in the whole country.

This is an opportune time to open the doors of the Chinese-funded Kenyatta University Teaching and Referral hospital. We have a fully furnished hospital with the most modern diagnostic and treatment machines going to waste as the University and the Ministry of Health fight turf wars over who should run it. Yet this is a facility that can assist in the UHC at a referral level and also help decongest the Kenyatta National Hospital. doctors who lecture in Kenyatta University had offered their services to help this facility open.

The Ministry of Health is spending billions of shillings annually in ‘leasing’ of single use items such as syringes, while refusing to spend a few hundred or a few thousand shillings on surgical instruments that can safe a baby’s life.

INSTRUMENTS

What is the value of an X-ray if it shows the doctor that a child has swallowed a coin, but the child dies in the waiting bay because the hospital has no instruments to remove the coin?

What value is a CT Scan showing that a patient has cancer, yet we do not have radiotherapy facilities in each country or at least in half of them? Why does the government send free donated chemotherapy cancer medications to the private hospitals instead of the government hospitals?

All doctors, like all Kenyans, support the Universal Health Coverage programme. It should be implemented. However, interfering with private hospitals and private medical practitioners will not facilitate what remains a public sector programme. What the common man in Turkana or ordinary woman in Tana River expects is to walk to the local health centre and receive treatment for the common disease that ails them.

If they are referred elsewhere, they expect this to be within their county or a nearby county so that the costs of seeking healthcare are also minimised.

Dr Gikonyo is a consultant Ear, Nose & Throat specialist and Head & Neck Surgeon in Nairobi. E-mail: [email protected]