The year is 2008 and I was a medical student working at the hospital in Eldoret, Western Kenya. Moi and Indiana University formed a collaboration that was inspired by a visiting physician that identified the need to optimize care for HIV patients in the early years of the pandemic. This collaboration has grown to multiple North American collaborators – including Indiana University, Brown University, UCSF and University of Toronto – that have sent and hosted medical students and residents over the last decade.
For the purpose of the story we shall name the visiting doctor as Dr. X. Dr. X was on her first visit to Africa and she came prepared – a blog with her first visit already posted, appropriate attire, and the mosquito repellent. On the first of the wards, she could not hide her shock on seeing three patients sharing a queen bed, lack of an insolation ward for patients with positive tuberculosis, and the two nurses running a fifty bed ward filled to capacity.
None of these prepared her for the practice of medicine in Kenya, where labs were missing at bedside, no official read for x-rays were available, no ICU beds were available, and vital signs were scribbled on a sheet of paper hanging at the foot of the bed. Patient Z was the breaking point for Dr. X. He was a HIV patient with suspected meningitis awaiting investigations since the parents could not afford the tests. Back at the hostel, Dr. X couldn’t help but share her frustration with other people visiting with her. Other residents and medical students who were visiting chimed in on how inefficient the health system was and the lack of understanding on pricing models at the hospital. There was a critical need for more transparency if any meaningful healthcare was going to be delivered to these patients.
Dr. X paired up with the medical students from the local university to understand and create more transparency for pricing. The first prototype was in Kenyan shillings and dollars – a quick test showed that this only promoted confusion. The next iteration led to the tool shared among all visiting residents and medical students. This tool utilises local resources that would be owned by a patients to explain to them that medical costs. For example, a chicken is equivalent to the cost of a chest x-ray, a cow is equivalent to the cost of an MRI scan. Three goats, sometimes two, are equivalent to a cost of a CT scan. While there were numerous challenges to be tackled, tackling price transparency inspired trust of the provider team and promoted willingness to pay for necessary testing for the patient.
This experience challenged me to rethink price transparency in areas where health and financial literacy remains low. I have subsequently studied the menu pricing by the Northwest Radiology Group that informs you on expectations for your copay whether insurance cover portion of the price or not.
Judy Gichoya enjoys writing code to save lives. A medical doctor from Kenya, she has worked in global health informatics over the last decade. She is a third year radiology resident at Indiana University and passionate on global health and informatics. Judy’s essay was submitted as part of the 2015 Costs of Care, HFMA, Strata Decision Technology, and Yale New Haven Health’s contest entitled The Best Care, The Lowest Cost – One Idea at a Time.