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Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Registry

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Abstract

Background

Half of the global population is at risk for catastrophic health expenditure (CHE) in the event that they require surgery. Universal health coverage fundamentally requires protection from CHE, particularly in low- and middle-income countries (LMICs). Financial risk protection reports in LMICs covering surgical care are limited. We explored the relationship between financial risk protection and hospital admission among injured patients in Cameroon to understand the role of health insurance in addressing unmet need for surgery in LMICs.

Methods

The Cameroon National Trauma Registry, a database of all injured patients presenting to the emergency departments (ED) of three Cameroonian hospitals, was retrospectively reviewed between 2015 and 2017. Multivariate regression analysis identified predictors of hospital admission after injury and of patient report of cost inhibiting their care.

Results

Of the 7603 injured patients, 95.7% paid out-of-pocket to finance ED care. Less than two percent (1.42%) utilized private insurance, and more than half (54.7%) reported that cost inhibited their care. In multivariate analysis, private insurance coverage was a predictor of hospital admission (OR 2.17, 95% CI: 1.26, 3.74) and decreased likelihood of cost inhibiting care (OR 0.34, 95% CI: 0.20, 0.60) when compared to individuals paying out-of-pocket.

Conclusion

The prevalence of out-of-pocket spending among injured patients in Cameroon highlights the need for financial risk protection that encompasses surgical care. Patients with private insurance were more likely to be admitted to the hospital, and less likely to report that cost inhibited care, supporting private health insurance as a potential financing strategy.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Pooja A. Shah, S. Ariane Christie & Girish Motwani

  2. Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon

    Fanny Nadia Dissak-Delon

  3. Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon

    Alain Chichom Mefire

  4. Emergency Unit, Laquintinie Hospital of Douala, Douala, Cameroon

    David Mekolo

  5. Catholic Hospital of Pouma, Pouma, Cameroon

    Gertrude Mete Ngono

  6. Department of Surgery, University of California, 10833 Le Conte Avenue, 72215 CHS, Los Angeles, CA, 90095, USA

    Rochelle Dicker & Catherine Juillard

  7. Cameroon Department of Disease Control, Ministry of Public Health, Yaoundé, Cameroon

    Georges Alain-Mballa Etoundi

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  1. Pooja A. Shah
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Correspondence to Catherine Juillard.

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The authors declare that they have no conflicts of interest related to this submission.

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Ethical approval was obtained from the Institutional Review Boards of UCSF, the Cameroonian National Ethics Committee, and the University of Douala.

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Shah, P.A., Christie, S.A., Motwani, G. et al. Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Registry. World J Surg 44, 3268–3276 (2020). https://doi.org/10.1007/s00268-020-05632-w

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  • DOI: https://doi.org/10.1007/s00268-020-05632-w

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