Tanywe Ashangwa Constantine, Pemunta Ngambouk Vitalis, Nimar Vidarah, Angwe Cybel Nji, Fubah Mathias Alubafi, Nyok Maurine Ekun, Bosire Tom Obara, Tram Nguyen Ngoc Bich, Njee Brendabell Ebanga, Hira Womma Habiba
Department of Anthropology, University of Yaounde I, Yaounde, Cameroon.
Cameroon Center for Evidence Based Health Care, Yaounde, Cameroon.
Front Public Health. 2025 Aug 26;13:1602798. doi: 10.3389/fpubh.2025.1602798. eCollection 2025.
This study investigates the structural and socio-cultural drivers of medical indebtedness and hospital detention due to unpaid healthcare bills in the Fundong Health District, Cameroon. It explores how poverty, institutional shortcomings, and cultural beliefs converge to exacerbate patients' financial vulnerability and delay access to care.
A qualitative anthropological approach was employed between February and November 2022, combining 34 in-depth interviews with extended ethnographic observation in hospital wards, billing offices, and family waiting areas. Data were analyzed using iterative grounded theory methods, including open, axial, and selective coding of interview transcripts, focus group discussions, and field notes. This methodology allowed for a nuanced understanding of how debt and detention are experienced and perpetuated. All data were transcribed, manually coded, and analyzed using NVivo 14 software to identify recurring themes related to hospital detention.
The findings show that medical indebtedness is driven by poverty, lack of health insurance, and limited social support. Institutional factors-including underfunded healthcare infrastructure and high user fees-compound these vulnerabilities. Cultural norms, such as beliefs discouraging financial preparation for illness, further heighten exposure to risk. The practice of hospital detention, though largely undocumented, imposes severe physical, emotional, and financial burdens, prompting some to delay care or adopt harmful coping mechanisms.
CONCLUSION/POLICY IMPLICATIONS: Addressing medical debt and hospital detention requires a multifaceted policy response. Recommendations include eliminating maternal user fees, expanding health insurance coverage for vulnerable populations, protecting hospital-based social assistance, and replacing detention with legal safeguards and social mediation. Additionally, culturally sensitive financial literacy and mental health support programs are vital. Long-term investment in health infrastructure and governance is essential to reduce out-of-pocket spending and ensure equitable, rights-based healthcare access.
本研究调查了喀麦隆丰东卫生区因未支付医疗费用导致医疗债务和住院扣留的结构及社会文化驱动因素。它探讨了贫困、机构缺陷和文化信仰如何相互交织，加剧患者的经济脆弱性并延误就医。
2022年2月至11月采用了定性人类学方法，结合34次深度访谈以及在医院病房、计费办公室和家属等候区进行的扩展民族志观察。使用迭代扎根理论方法对数据进行分析，包括对访谈记录、焦点小组讨论和实地笔记进行开放式、轴心式和选择性编码。这种方法有助于细致入微地理解债务和扣留是如何产生及持续存在的。所有数据都进行了转录、手动编码，并使用NVivo 14软件进行分析，以识别与住院扣留相关的反复出现的主题。
研究结果表明，医疗债务是由贫困、缺乏医疗保险和有限的社会支持驱动的。机构因素，包括资金不足的医疗基础设施和高昂的用户费用，使这些脆弱性更加复杂。文化规范，如不鼓励为疾病进行财务准备的观念，进一步增加了风险暴露。住院扣留的做法虽然大多没有记录，但带来了严重的身体、情感和经济负担，促使一些人推迟就医或采取有害的应对机制。
结论/政策建议：解决医疗债务和住院扣留问题需要多方面的政策回应。建议包括取消孕产妇用户费用、扩大弱势群体的医疗保险覆盖范围、保护基于医院的社会援助，并用法律保障和社会调解取代扣留。此外，具有文化敏感性的金融知识普及和心理健康支持项目至关重要。对卫生基础设施和治理进行长期投资对于减少自付费用并确保公平、基于权利的医疗服务可及性至关重要。
