Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Reg
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ORIGINAL SCIENTIFIC REPORT
Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Registry Pooja A. Shah1 • S. Ariane Christie1 • Girish Motwani1 • Fanny Nadia Dissak-Delon2 • Alain Chichom Mefire3 • David Mekolo4 • Gertrude Mete Ngono5 • Rochelle Dicker6 • Georges Alain-Mballa Etoundi7 • Catherine Juillard6
Ó Socie´te´ Internationale de Chirurgie 2020
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.
& Catherine Juillard [email protected] 1
Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
2
Littoral Regional Delegation, Ministry of Public Health, Douala, Cameroon
3
Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
4
Emergency Unit, Laquintinie Hospital of Douala, Douala, Cameroon
5
Catholic Hospital of Pouma, Pouma, Cameroon
6
Department of Surgery, University of California, 10833 Le Conte Avenue, 72215 CHS, Los Angeles, CA 90095, USA
7
Cameroon Department of Disease Control, Ministry of Public Health, Yaounde´, Cameroon
123
World J Surg
Introduction An estimated 5 billion people around the world do not have access to safe and affordable surgical care [1]. Lack of access to surgery is not uniform, with less than 10% of operations performed on the poores
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