Recovery of Medical Costs in Cameroon's Health Facilities: State of Play, Challenges and Prospects

In Cameroon, the majority of healthcare costs (70%) are borne by households that pay directly at the level of health facilities (HFs). Despite the implementation of new health policies as phase II UHC, individuals continue to support their health expenses through out-of-pocket payments and the non-payment of medical expenses is still a major problem in Cameroonian health facilities. The objective of this work is to study the system of recovery of medical expenses in some HFs in order to propose strategies for improving the management medical fee collection and reduced the problems related to non-payment of medical bills. This study involved 500 people, including 100 health personnel directly involved in the management of medical fees collection (accountants, cashiers, administrative and health staff) and 400 other people
(patients and visitors), from the Littoral, Centre and West regions. This was a prospective investigation where the collection technique was by interview (written, semi-directive, face-to-face interview) for staff and by written questionnaire for patients or the general population. The study found that the majority of staff respondents (involved in the recovery of medical expenses) were dominated by people with more than 5 years’ work experience (45%) and 9.00% of them believe that medical costs were very expensive. The medical expenses for which unpaid bills were noted are mainly consultation costs (37%), followed by hospitalization costs (32%), medical expenses were paid after the service (19.38%); 4% of respondents paid for them to staff; 38.77% received a manual receipt and stress was the major health problem related to paying medical expenses for 60.82% of participants. The unpaid bills observed does the Cameroonian population endure the result of poverty (27%) as well as the lack of financial means (25%); the high cost of health services coupled with the lack of true Universal Health Coverage also partly explains this situation of unpaid bills. In addition, patients with unpaid bills are held back or pressured to pay their bills before they are allowed to leave hospitals. In order to improve the Cameroonian health system, particularly in terms of health cost management, we recommend the development of a robust and less laborious computerized system for the recovery of medical costs, the awareness of the population on health insurance as well as the optimization of the mechanisms for registering the population in insurance companies. In addition, the costs of medical services should be reviewed and mechanisms for assistance to the indigent should be developed. The implementation of UHC could finally give every Cameroonian citizen the opportunity to access quality health care. In view of all the results and in order to improve the management of the recovery of medical expenses in Cameroonian HFs, we recommend the development of a robust and less laborious computerized system for the recovery of medical expenses. In addition, the costs of medical services should be reviewed and mechanisms for assistance to indigent persons should be further developed.