HEALTH FINANCING IN MANAGEMENT OF TRAUMA AT A COUNTY REFERRAL HOSPITAL Dr. Kaberia P., Dr. Nyotu G., Dr. Ngatia., Dr. Nyongesa D. 1

Content Introduction Objectives Methodology Results Discussion Concusion references 2

Introduction Trauma is a near epidemic in Africa, rivaling infections in the toll they take on young lives1 The estimated cost as a percentage of the Gross National Product (GNP) in Kenya is almost 5%2. 20% of Kenyans have access to some sort of medical insurance coverage3. This study looks at health insurance as a step towards averting financial hardships associated with out-of-pocket (OOP) payments among trauma patients

Objectives To describe the method of payment Out-of-pocket payment Health insurance schemes(NHIF) To describe the Morbidity and Mortality due to trauma Injuries sustained Duration of hospital stay Mortalities To estimate the Overall cost of treatment

Methodology Descriptive retrospective study Kericho County referral Hospital, department of Surgery. Sample size was 242 trauma in-patients Study period was between Jan 2016 and Jan 2017. Data was collected from Patient medical records of surgical patients Nursing reporting books, Records from theatre, radiology and accounts departments. The data was then analyzed using SPSS22, Microsoft Excel 2013. Ethical approval was sought from the Hospital ethics board. 5

Results We need the data on percentage who paid oop and those who had NHIF 6

Results

Discussion Burns, head injury and fractures to the lower limbs were the commonest trauma admissions in our study. This finding agrees with a study done in In Nakuru PGH in 1998/9 where RTAs (32.7%), Assaults(23.8%), Falls (15.5%) and Burns (13%) were the most common4. A similar picture was found in Embu county referral hospital where fractures to the lower limbs, burns and falls were among the common diagnosis5. This can be attributed to the 40-fold increase in motorcycle riders. noted between 2005-2011. The mean duration of Hospital stay for trauma patients was found to be 13.25 days. This was similar to findings in other County referral hospitals like Nakuru PGH 1998/9 was 10.4 days, Embu County and referral teaching hospital was 13 days. The average in Kenya had been described as 10 days by Oteino et al in 2004. 8

Discussion In Kericho District hospital the Average cost incurred by the trauma patient was found to be $272. 63 with a wide range from US$47.3 – US$724.3 with 80% paying Out of Pocket. Nyotu et al found the average cost to patient in Embu to be at USD 111. A study of surgical patients done in Bethsada clinic, Nigeria (2005 - 2009) showed that the hospital bills ranged from US$33.3 – US$500 and the mean cost was US$105.7. The main source of financing was OOP (71.8%) in Bethseda, Nigeria, and 62% In Embu.

Discussion The average cost reduction among patients with NHIF was 81% There was an 11.4% mortality rate among trauma patients in Nakuru PGH 1998/9 over twice the number of mortalities noted in our study(4.9%) 31.8% of the trauma patients in the study were however referred for ICU care/Burns unit care and Orthopedic/Neurosurgery review.

Conclusion The findings of this study will help health care professionals increase health insurance (NHIF) sensitization among focus groups(Motorcycle riders, PSV drivers etc) with the aim of reducing financial hardship associated with out of pocket payments.

References Surgical admissions to the Rift Valley Provincial General Hospital, Kenya. Masiira-Mukasa, Ombito BR.(1998 – 1999) Epidemiology of Trauma in Patients Admitted to an Emergency Ward in Yasuj,Iran. Mohammad Fararoei, Seyed Javad Sadat and Mohammad Zoladl(2011-2012) Sources of healthcare financing among surgical patients in a rural Niger Delta practice in Nigeria. Dienye PO, Brisibe SF, Eke R. ECONOMIC BURDEN OF MOTORCYCLE ACCIDENTS IN NORTHERN GHANA. M. KUDEBONG, F. WURAPA, J. NONVIGNON, I. NORMAN, J. K. AWOONOR-WILLIAMS and M. AIKINS.(2004 – 2008) Road traffic injuries in Kenya: a survey of commercial motorcycle drivers, Machakos Level V hospital Duncan Mwangangi Matheka & Faraj Alkizim Omar, Chebiwot Kipsaina, Jeffrey Witte.(2014)

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