Kibu Odette D, Kepgang Evrard, Sinsai Regina, Conner Anna, Asahngwa Constantine, Ngwa Wilfred, Ngo Ngo V, Fobellah Nkengafac N, Muenyi Clarisse S, Zalamea Nia N, Gobina Ronald M, Foretia Denis A
Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon.
Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon.
J Surg Res. 2024 Jan;293:158-167. doi: 10.1016/j.jss.2023.09.010. Epub 2023 Sep 27.
Surgical care is a significant component of the overall health expenditure in low- and middle-income countries. In Cameroon, out-of-pocket payments for surgical service are very high with many patients declining potentially curative surgical procedures. Less than 2% of the population is enrolled in a health insurance scheme leading to a propensity for catastrophic health expenses when accessing care. To assess the perceived barriers and motivations for health insurance subscription among health-care users in Cameroon.
This was a cross-sectional community-based qualitative study conducted in the Center Region of Cameroon. A total of 37 health-care users (health insurance subscribers and nonsubscribers) were purposively identified. Four focused group discussions and thirteen in-depth interviews were conducted. All anonymized transcripts were analyzed using a thematic analysis approach.
The six major themes identified as barriers to health insurance subscription were lack of trust in the existing health insurance schemes, inadequate knowledge on how health insurance works, premiums believed to be too expensive, the complexity of the claims processing system, minimal usage of health-care services and practice of self-medication. Motivational factors included the knowledge of having access to quality health services even without money in the event of an unforeseen illness and having a large family/household size. The importance of mass sensitization on the benefits of health insurance was noted.
Health insurance is still very underutilized in Cameroon. This results in significant out-of-pocket payment for health services by Cameroonians with catastrophic consequences to households. With most Cameroonians in the informal sector and underemployed, it is imperative to put in place a national strategic plan to overcome existing barriers and increase health insurance coverage especially among the poor. This has the potential to significantly increase access to safe, quality, timely and affordable surgical care.
外科护理是低收入和中等收入国家总体医疗支出的重要组成部分。在喀麦隆，外科服务的自付费用非常高，许多患者拒绝接受可能治愈的外科手术。不到2%的人口参加了医疗保险计划，这导致人们在获得医疗服务时容易产生灾难性医疗费用。为了评估喀麦隆医疗服务使用者对医疗保险参保的感知障碍和动机。
这是一项在喀麦隆中部地区开展的基于社区的横断面定性研究。共有意选取了37名医疗服务使用者（医疗保险参保者和未参保者）。进行了四次焦点小组讨论和十三次深入访谈。所有匿名的访谈记录均采用主题分析方法进行分析。
确定为医疗保险参保障碍的六个主要主题是对现有医疗保险计划缺乏信任、对医疗保险运作方式的了解不足、认为保费过高、理赔处理系统复杂、医疗服务使用极少以及自我药疗的习惯。激励因素包括了解到即使在突发疾病时没有钱也能获得优质医疗服务，以及家庭规模较大。指出了对医疗保险益处进行大规模宣传的重要性。
医疗保险在喀麦隆的利用率仍然很低。这导致喀麦隆人在医疗服务方面自付费用很高，给家庭带来灾难性后果。由于喀麦隆大多数人在非正规部门且就业不足，必须制定一项国家战略计划，以克服现有障碍并扩大医疗保险覆盖范围，特别是在贫困人口中。这有可能显著增加获得安全、优质、及时且负担得起的外科护理的机会。
