Information asymmetry in the Kenyan medical laboratory sector

ABSTRACT

Background

Important information about medical laboratory providers is not readily available to all patients, clinicians nor regulators in Kenya. This study was conducted as part of a wider project aiming to improve access to high quality diagnostics by addressing information asymmetries in the Kenyan market for laboratory services.

Objectives

The purpose of this study was to: 1) Gather pricing information for 49 common laboratory tests from medical laboratories in Nairobi, Kenya, noting where these prices were publicly available or withheld. 2) Assess patients’ knowledge of testing information including: turnaround time, price, and test availability.

Method

This was a cross-sectional study where a mystery caller approach was used to survey 49 tests for turnaround time, price, and availability across 13 laboratories selected purposively. The mystery shopper survey was complemented by 251 patient exit interviews at two Kenyan hospitals to understand whether patients seeking laboratory tests in Nairobi had access to such information. All 251 patients were selected by convenience sampling.

Results

We noted that 85% of the private laboratories did not disclose test prices and turnaround times to their patients. There was a wide range of prices on several key tests, with private in-facility laboratories charging an average test price of 468% of the average test price in public laboratories across all the 49 tests. We also found that many patients lacked key information regarding the tests they needed: 65% did not know the purpose of the test while 41% did not know the test price at all.

Conclusion

Under the current system, patients have limited access to information regarding the key criteria required to make a rational decision. This has a significant impact on the quality, price, and turnaround time (TAT) offered by the medical laboratories that operate in this dysfunctional market.

KEYWORDS:

• Essential diagnostics list
• Kenya
• diagnostics
• health systems
• pathology

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We want to thank the Kenyan Medical Laboratory Technician and Technologist Board (KMLTTB) and the health department of Nairobi county who permitted this work to be carried out. We also thank the hospital management and laboratory managers who supported the work in the survey hospitals. This work is published with the permission of the Director of the Kenyan Medical Research Institute (KEMRI).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Felix Bahati BSc: conception; design; data collection (mystery shopping and interviews); data analysis and interpretation; drafting; revisions.

Mike English PhD: conception; design; data analysis and interpretation; drafting; revisions.

Shahin Sayed PhD MD: data analysis and interpretation; drafting; revisions.

Susan Horton PhD: data analysis and interpretation; drafting; revisions.

Onyango Abel Odhiambo MSc: data analysis and interpretation; drafting; revisions.

Abdulatif A Samatar MSc: data analysis and interpretation; drafting; revisions.

Jacob McKnight PhD: conception; design; data analysis and interpretation; drafting; revisions.

Ethics and Consent

This work was granted ethical approval from the Institutional Ethics Review Committee of Aga Khan University hospital in Kenya (Ref: 2017/REC-104(v6)). Informed written consent was secured for all patients or guardians who participated in hospital interviews. We ensured that the interviews did not inconvenience patients and healthcare providers in any way. Confidentiality of the study participants was addressed by storing the collected data on secure servers of KEMRI-Wellcome Trust and password-protected computers. All the clinical laboratories that took part in the mystery shopper approach were anonymised such that they cannot be identified. The test prices obtained from the laboratories are reported in this publication in summary form, such as means, median and percentages without disclosing any personal information that could lead to identification of the facilities.

Paper context

What was already known

We know that patients struggle to access effective, timely and affordable diagnostics in LMICs and that this limits overall quality.

What’s new

We sought to understand whether patients in Nairobi have access to testing information such as test price, turnaround time, quality certifications and the related knowledge gap.

What action needs to be taken

Clinical laboratories, especially those in the private sector, need to make testing information readily available to the patients in order for them to make more rational choices.

Additional information

Funding

This work was supported by the Bill and Melinda Gates Global Challenge Exploration scheme awarded to JM (Grant number: 111222333). The funder had no role in the preparation of this manuscript or the decision to submit for publication; Bill and Melinda Gates Foundation [OPP1180942].