Factors contributing to post discharge stay at Kenyatta National Hospital, Nairobi

Abstract

Discharge planning is embedded in the clinical pathway of patient’s treatment in hospitals during overnight admissions. Actual discharge from a hospital allows patients to leave the facility and convalescence at their homes while preparing to resume normal lives. This also creates space for other overnight admissions and eases stress within the referral system. However, a number of patients are unable to leave health facilities after clinical discharge where co-payments and user fees are required to facilitate clearance. This study was based at Kenyatta National Hospital (KNH), the apex of the referral health care system in Kenya and sought to understand factors that contribute to post discharge stay (PDS) in KNH. This study evaluated the effects of socio-demographic, health insurance status, social support and nature of illness as components of post discharge stay in KNH. Moreover, factors contributing to post discharge stay as a barrier of exit from a health facility has not been systematically explored by previous research as most studies have dwelt on access and equity of healthcare. This descriptive survey targeted discharged patients in KNH who were unable to clear their hospital bills and health workers involved in the administration of systems which assist discharged patients leave the hospital. Patients (n=186) had an average post discharge stay of 33.3 (SD 12.6) days, and 78% came from Nairobi and its metropolis. Further, 52% of the patients were not referred to the facility while only 17.2% reported to have no occupation. Of the patients with No NHIF (95.5%), 78.6% cited lack of knowledge on NHIF benefits as nonenrolment reason. Patients with higher level of social support were able to obtain instrumental aid (p=0.000) than those with low levels of social support, although the support was not substantial enough to wholly influence post discharge stay. Although social-demographic and clinical characteristics were not statistically significant with post discharge stay, a positive trend was observed as both influenced ability to pay and size of hospital bills respectively. Importantly, the ability to leave the facility was at the discretion of the hospital administration and the absence of a viable coping mechanism within households influenced post discharge stay. The results revealed two post discharge groups with distinctive characteristics. The low income group with low risk aversion and were willing to pay an agreed pre-payment premium and the impoverished poor. From a NHIF hypothetical model, 90.3% of outstanding bills would be covered in full while 9.7% would be co-shared and this showed health insurance status would influence post discharge stay. Therefore, NHIF and other forms of pre-payment should be considered as an integral part in public health care financing. Projects to enhance the low penetration of health insurance for unregistered eligible members of the population should be adopted. Medical programmes should seek convergence with economic programmes such as social protection initiatives for vulnerable groups involving clear eligibility criteria and matching funds provided to sustain health facilities.