Gender Differences in Insurance, Surgical Admissions and Outcomes at a Kenyan Referral Hospital

• Published in: The Journal of surgical research Vol. 268; pp. 199 - 208
• Main Authors: Gillio, Anna M., Li, Helen W., Bhatia, Manisha B., Chepkemoi, Eunice, Rutto, Emmy J., Carpenter, Kyle L., Saruni, Seno I., Keung, Connie H., Hunter-Squires, JoAnna L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021
• Subjects: Gender disparity; General surgery; Global surgery; Healthcare disparity; Low- and middle-income countries (LMIC); National hospital insurance fund (NHIF); National hospital insurance fund (NHIF); Low- and middle-income countries (LMIC); General surgery; Healthcare disparity; Global surgery; Gender disparity
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.06.014

Gender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya's National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya.
All patients ≥13 years admitted to the general surgery service at Moi Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests.
366 patients were included for analysis. 48.6% were enrolled in NHIF with significant female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male and female patients underwent surgery and suffered in-hospital mortality at similar rates. However, women only comprised 39.6% of admissions and were significantly more likely to delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus 13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P = 0.013).
Many financial and cultural barriers exist in Kenya that prevent women from accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.