Penda Calixte Ida, Eposse Ekoube Charlotte, Mbono Betoko Ritha, Nlend Cedric, Eyoum Bilé Bertrand, Ateba Ndongo Francis, Boupda Loic, Kedy Koum Daniele Christiane, Eboumbou Moukoko Carole, Bita Fouda André, Richard Njock Louis
Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
Laquintinie Hospital of Douala, Douala, Cameroon.
PLoS One. 2025 Jun 5;20(6):e0322615. doi: 10.1371/journal.pone.0322615. eCollection 2025.
The lack of health cover in low-income countries is a real barrier to emergency care. The objective of our study was to evaluate the immediate management of pediatric emergencies by deferred recovery of the costs of care at Douala Laquintinie Hospital. A prospective cross-sectional study was conducted from 1st February to 30 June 2020 on patients admitted for life-threatening emergencies to the pediatric emergency department. Deferred recovery of healthcare costs was triggered by the issuance of a "green voucher, an internal reimbursement voucher issued by the doctor for expenses incurred upon patient admission in a life-threatening emergency and reimbursable within 72 hours after initial emergent management was received. Of the 786 patients admitted to the pediatric emergency department, 502 (63.8%) patients presented with a life-threatening emergency at a median age of 1 year [IQR: 0-5]. According to the indigence criteria, 40.4% of the patients were indigent and nearly 40% of the families' patients declared having a monthly income < 50,000 franc of the French Colonies of Africa (FCFA) or 85 USD. The majority of patients with life-threatening 456 (90.8%) had benefited from the "green voucher" and 71.5% from care within 15 minutes of admission. The average household health expenditure during hospitalization was 143.9 ± 52.3 USD (53.5-393.9). A total of 76.1% of patients benefited from deferred care cost recovery, including 43.6% from moratorium payment facilities. The mortality rate was 9.8%. The deferred healthcare cost recovery system has proven effective in lowering avoidable child mortality in life-threatening emergencies, despite the heavy burden of healthcare costs for the underprivileged.
低收入国家缺乏医保是获得急诊护理的一大现实障碍。我们研究的目的是评估在杜阿拉拉昆蒂尼医院通过延迟收回护理费用来对儿科急诊进行即时管理的情况。2020年2月1日至6月30日，我们对儿科急诊科收治的危及生命的急诊患者进行了一项前瞻性横断面研究。医疗费用的延迟回收是通过发放“绿色代金券”触发的，“绿色代金券”是医生开具的一种内部报销凭证，用于支付患者因危及生命的急诊入院时产生的费用，在收到初始紧急治疗后的72小时内可报销。在儿科急诊科收治的786名患者中，502名（63.8%）患者出现危及生命的急诊情况，中位年龄为1岁[四分位间距：0 - 5岁]。根据贫困标准，40.4%的患者为贫困人口，近40%患者的家庭宣称月收入低于非洲法属殖民地法郎（FCFA）50,000法郎或85美元。大多数出现危及生命情况的患者456名（90.8%）受益于“绿色代金券”，71.5%的患者在入院15分钟内得到了治疗。住院期间家庭平均医疗支出为143.9 ± 52.3美元（53.5 - 393.9美元）。共有76.1%的患者受益于延迟护理费用回收，其中43.6%受益于延期支付设施。死亡率为9.8%。尽管贫困人群的医疗费用负担沉重，但延迟医疗费用回收系统已证明在降低危及生命的急诊中可避免的儿童死亡率方面是有效的。
