Do deferred emergency payment programmes increase use of injury care services in Cameroon? A trauma registry analysis

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.