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

• Published in: World journal of surgery Vol. 44; no. 10; pp. 3268 - 3276
• Main Authors: Shah, Pooja A., Christie, S. Ariane, Motwani, Girish, Dissak-Delon, Fanny Nadia, Mefire, Alain Chichom, Mekolo, David, Ngono, Gertrude Mete, Dicker, Rochelle, Etoundi, Georges Alain-Mballa, Juillard, Catherine
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-10-2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Cameroon - epidemiology; Cardiac Surgery; Catastrophic events; Child; Cost analysis; Emergency medical care; Emergency medical services; Emergency Service, Hospital - economics; Female; Financing; General Surgery; Health Expenditures; Health insurance; Health risks; Hospitalization - economics; Humans; Injuries; Injury analysis; Insurance; Insurance Coverage; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Original Scientific Report; Patient Admission; Patients; Registries; Regression analysis; Retrospective Studies; Risk; Surgery; Thoracic Surgery; Trauma; Trauma centers; Vascular Surgery; Wounds and Injuries - epidemiology; Wounds and Injuries - therapy; Young Adult; Cameroon
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05632-w

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.