Dissak-Delon Fanny Nadia, O'Connor Kathleen, Yost Mark T, Dzemo Kibu O, Zheng Dennis J, Oke Rasheedat, Umoh Cindy S, Christie Ariane S, Chichom Mefire Alain, Juillard Catherine
Department of Public Health, Faculty of Health Sciences, University of Bamenda, Bambili, NW Region, Cameroon
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
BMJ Glob Health. 2025 Mar 25;10(3):e017760. doi: 10.1136/bmjgh-2024-017760.
Injured patients in Cameroon face high out-of-pocket costs and care discrepancies based on ability to pay. Per government declaration, all Cameroonian hospitals instituted emergency payment deferral (EPD) programmes to mitigate financial barriers to emergency care. Doctors or nurses decide on patients' eligibility for the EPD programme. However, the impact of EPD on care patterns is unclear.
The Cameroon Trauma Registry (CTR) is a prospective, multisite trauma registry collecting injured patient data from four hospitals in Cameroon. Using CTR data from March 2020 to February 2022, we analysed associations between patient participation in EPD programmes and healthcare interventions using univariate analysis and multivariate logistic regression.
Of 5287 CTR patients, 58% (n=3081) were emergency payment deferral recipients (EPDR). A greater proportion of EPDR lived in urban residences (89% EPDR vs 87% non-EPDR, p=0.003). EPDR more often presented with a 'serious' or more severe estimated injury severity (70% EPDR vs 59% non-EPDR, p<0.001). Compared with non-recipients, a smaller proportion of EPD recipients, a smaller proportion of EPDR underwent recommended X-rays (48% EPDR vs 51% non-EPDR, p<0.001). However, greater percentages of EPDR received a recommended ultrasound (3% vs 1%, p<0.001) or CT scan (14% EDPR vs 10% non-EDPR, p<0.001). EPDR more often did not receive radiological tests due to inability to pay (12% vs 4%, p<0.001). Moreover, 10% of EPDR did not undergo recommended surgery due to cost while 6% of non-EPDR did not undergo recommended surgery due to cost (p<0.001). Multivariate logistic regression controlling for injury severity and other demographics indicates that EPDR were less likely to undergo surgery (adjusted OR=0.63, p=0.001).
Payment deferral programmes were associated with increased use of some imaging tests, but did not fully address the downstream financial barriers that impede health equity in Cameroon.
喀麦隆的受伤患者面临高额自付费用以及基于支付能力的医疗差异。根据政府声明，喀麦隆所有医院都设立了紧急支付延期（EPD）计划，以减轻紧急医疗的经济障碍。医生或护士决定患者是否符合EPD计划的资格。然而，EPD对医疗模式的影响尚不清楚。
喀麦隆创伤登记处（CTR）是一个前瞻性、多地点的创伤登记处，收集喀麦隆四家医院的受伤患者数据。利用2020年3月至2022年2月的CTR数据，我们通过单变量分析和多变量逻辑回归分析了患者参与EPD计划与医疗干预之间的关联。
在5287名CTR患者中，58%（n = 3081）是紧急支付延期接受者（EPDR）。更大比例的EPDR居住在城市地区（89%的EPDR对87%的非EPDR，p = 0.003）。EPDR更常表现出“严重”或更严重的估计损伤严重程度（70%的EPDR对59%的非EPDR，p < 0.001）。与非接受者相比，EPD接受者中接受推荐X光检查的比例较小（48%的EPDR对51%的非EPDR，p < 0.001）。然而，更高比例的EPDR接受了推荐的超声检查（3%对1%，p < 0.001）或CT扫描（14%的EDPR对10%的非EDPR，p < 0.001）。EPDR因无力支付而更常未接受放射学检查（12%对4%，p < 0.001）。此外，10%的EPDR因费用问题未接受推荐的手术，而6%的非EPDR因费用问题未接受推荐的手术（p < 0.001）。控制损伤严重程度和其他人口统计学因素的多变量逻辑回归表明，EPDR接受手术的可能性较小（调整后的OR = 0.63，p = 0.001）。
支付延期计划与某些影像学检查的使用增加有关，但并未完全解决阻碍喀麦隆健康公平的下游经济障碍。
