Cynthia Adanze Nge, Kılıç Bülent
Integrated Health Organization, Buea, Cameroon.
School of Medicine, Faculty of Health Sciences, Department of Public Health, Dokuz Eylul University, Izmir, Turkey.
Health Econ Rev. 2025 Jul 12;15(1):59. doi: 10.1186/s13561-025-00655-2.
The global push to achieve universal health coverage (UHC) by 2030 has gained widespread attention, with many countries, including low- and middle-income nations like Cameroon, striving to implement reforms. However, financial, infrastructural, and systemic barriers make achieving UHC in Cameroon challenging. In pursuit of this goal, health insurance systems, particularly private health insurance, have been increasingly promoted to reduce out-of-pocket health expenses. However, the key question remains whether patients receive value for their money. This study aimed to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon, with a focus on awareness, satisfaction, and the challenges influencing its accessibility and functionality.
Following ethical approvals, this study employed a qualitative exploratory design, using key informant interviews (KII) to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon. The study focused on awareness, satisfaction, and challenges influencing accessibility and functionality. Reflective thematic analysis was used to identify important aspects of our study.
To ensure that the identified themes accurately represented the data and remained distinct, they were systematically reviewed and refined. This process resulted in five main themes: (1) Accessibility and Quality of Healthcare Services, (2) The Financial Paradox of Health Insurance, (3) Structural and Operational Challenges in the Health Insurance Framework, (4) Information Gaps and Awareness about Health Insurance, and (5) Divergent Experiences and Perspectives on Health Insurance Effectiveness. All participants agreed that health insurance reduces out-of-pocket health costs. Uninsured patients cited high premiums, distrust in the healthcare system, and insufficient knowledge about insurance options as reasons for not enrolling. Insured patients expressed significant dissatisfaction with their insurance packages, particularly with lengthy reimbursement processes and inadequate medical coverage.
The findings indicate a general agreement on the benefits of health insurance in Cameroon. To improve enrolment and satisfaction, premiums need to be made affordable across all socioeconomic levels, and consider increasing information dissemination and publicity about insurance options. Streamlining reimbursement processes is also crucial.
到2030年实现全民健康覆盖（UHC）的全球努力已受到广泛关注，包括喀麦隆等低收入和中等收入国家在内的许多国家都在努力进行改革。然而，财政、基础设施和体制障碍使得喀麦隆实现全民健康覆盖具有挑战性。为了实现这一目标，医疗保险系统，特别是私人医疗保险，得到了越来越多的推广，以减少自付医疗费用。然而，关键问题仍然是患者是否物有所值。本研究旨在探讨喀麦隆患者和医疗服务提供者对医疗保险有效性的看法，重点关注认知度、满意度以及影响其可及性和功能的挑战。
在获得伦理批准后，本研究采用定性探索性设计，通过关键信息人访谈（KII）来探讨喀麦隆患者和医疗服务提供者对医疗保险有效性的看法。该研究聚焦于认知度、满意度以及影响可及性和功能的挑战。采用反思性主题分析来确定我们研究的重要方面。
为确保所确定的主题准确反映数据并保持清晰，对其进行了系统的审查和完善。这一过程产生了五个主要主题：（1）医疗服务的可及性和质量；（2）医疗保险的财务悖论；（3）医疗保险框架中的结构和运营挑战；（4）关于医疗保险的信息差距和认知度；（5）对医疗保险有效性的不同体验和观点。所有参与者都认为医疗保险降低了自付医疗费用。未参保患者将高额保费、对医疗系统的不信任以及对保险选项的了解不足作为未参保的原因。参保患者对他们的保险套餐表示极大不满，特别是对冗长的报销流程和不足的医疗覆盖范围。
研究结果表明，喀麦隆对医疗保险的益处普遍达成共识。为了提高参保率和满意度，需要使所有社会经济阶层都能负担得起保费，并考虑增加关于保险选项的信息传播和宣传。简化报销流程也至关重要。
