Abstract:
Background: Patients at Kenyan public hospitals are detained if their families cannot pay their
medical bills. Access to health insurance and waiving procedures to prevent detention may be
limited. This study explores the perspectives of health-care providers (HCP) on health-insurance
access, waiving procedures, and hospital detention practices.
Procedure: A self-administered structured questionnaire was completed by 104 HCP (response
rate 78%) involved in childhood cancer care.
Results: The perspectives of respondents were as follows: all children with cancer should have
health insurance according to 96% of HCP. After parents apply for health insurance, it takes too
long before treatment costs are covered (67% agree). Patients with childhood cancer without
health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should
waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving
procedures take too long (75%). Parents are scared by waiving procedures and may decide never
to return to the hospital again (68%). Poor families delay visiting the hospital because they fear
hospital detention and first seek alternative treatment (92%). When poor families finally come to
the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon
their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at
the hospital if parents cannot pay their medical bills is not approved by 84% of HCP.
Conclusions: HCP acknowledge that access to health insurance needs improvement and that
waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospi-
tal detention practices. These factors warrant urgent attention and adjustment.
