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Abstract
Résumé
Introduction. Chaque année, plus de 300 millions d’interventions chirurgicales sont réalisées dans le monde, avec un taux de mortalité postopératoire précoce supérieur à 4 %, touchant principalement les pays à revenu faible ou intermédiaire comme le Cameroun. Si les études menées dans les pays développés montrent que l’assurance maladie (HI) peut influencer les résultats chirurgicaux, très peu d’analyses ont été effectuées dans les contextes africains. Cette étude vise à évaluer l’impact de l’assurance maladie sur les résultats postopératoires dans notre environnement en comparant les résultats chirurgicaux des patients bénéficiant d’une assurance santé à ceux n’en disposant pas. Méthodologie. Il s’agit d’une étude rétrospective réalisée sur trois mois au service de chirurgie de l’Hôpital Régional de Buea. Les données socio-démographiques et cliniques de patients opérés durant l’année écoulée ont été recueillies et comparées selon leur statut d’assurance. L’analyse statistique a été effectuée à l’aide du logiciel SPSS version 23. Résultats. 542 patients ont été inclus (âge moyen : 32,78 ± 20,48 ans). Seuls 20,3 % étaient assurés, majoritairement via MSF (97 %). Les assurés présentaient un délai moyen plus long entre le diagnostic et la chirurgie (3,4 jours vs 1,72 jours) et plus de comorbidités (10,9 % vs 6,9 %). Les complications postopératoires étaient plus fréquentes chez les assurés (33,6 % vs 24 %), sans différence statistique significative. Cependant, la mortalité postopératoire était significativement plus élevée chez les assurés (4,7 % vs 2,3 %, p = 0,021). Conclusion. L’assurance maladie n’a pas influencé de manière significative les délais opératoires ni les complications, mais elle est associée à un taux de mortalité plus élevé, probablement en lien avec la gravité des cas assurés.
Abstract
Introduction. Each year, over 300 million surgical interventions are performed worldwide, with an early postoperative mortality rate exceeding 4%, predominantly affecting low- and middle-income countries like Cameroon. While studies in developed countries show that Health Insurance (HI) can influence surgical outcomes, very few analyses have been conducted in African settings. This study aims to evaluate the impact of health insurance on postoperative outcomes in our environment by comparing the surgical results of patients with health insurance to those without. Methodology. This was a retrospective study conducted over three months in the surgery department of the Buea Regional Hospital. Socio-demographic and clinical data from patients who underwent surgery during the preceding year were collected and compared according to their insurance status. Statistical analysis was performed using SPSS version 23 software. Results. A total of 542 patients were included (mean age: 32.78±20.48 years). Only 20.3% were insured, primarily through MSF (97%). Insured patients presented with a longer average delay between diagnosis and surgery (3.4 days vs 1.72 days) and more comorbidities (10.9% vs 6.9%). Postoperative complications were more frequent among insured patients (33.6% vs 24%), though this difference was not statistically significant. However, postoperative mortality was significantly higher among insured patients (4.7% vs 2.3%, p=0.021). Conclusion. Health insurance did not significantly influence operative delays or complications, but it was associated with a higher mortality rate, likely related to the greater severity of the cases among insured patients.
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References
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References
1. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624.
2. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: A modelling strategy based on available data. Lancet. 2008;372(9633):139–44.
3. Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, Ademuyiwa A, et al. Global burden of postoperative death. Lancet. 2019;393(10170):401.
4. Folefack DP, Bella H, Monebenimp F, Essomba NE, Adiogo D, Mouaffo A, et al. L’accès financier aux soins de santé au Cameroun: État des lieux et perspectives. Health Econ Rev. 2020;10(1):1–7.
5. Kruk ME, Goldmann E, Galea S. Borrowing and selling to pay for health care in low- and middle-income countries. Health Aff. 2009;28(4):1056–66.
6. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007;26(4):972–83.
7. Schoenfeld AJ, Ochoa LM, Bader AM, Belmont PJ, Blucher JA, Ferrone ML, et al. Insurance status and hospital complications in major spine operations. Spine J. 2014;14(8):1726–33.
8. Haider AH, Schneider EB, Sriram N, Dossick DS, Scott VK, Efron DT, et al. Uninsured patients undergo less frequent diagnostic imaging and have higher mortality after trauma. J Trauma Acute Care Surg. 2014;76(2):304–10.
9. Criel B, Waelkens MP. Declining subscriptions to the Maliando mutual health organisation in Guinea-Conakry (West Africa): what is going wrong? Soc Sci Med. 2003;57(7):1205–19.
10. Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health inequality in South Africa: Evidence from General Household Surveys. Int J Equity Health. 2011;10:48.
11. WHO. Health Financing Strategy for the African Region 2010–2015. Brazzaville: WHO Regional Office for Africa; 2010.
12. Ministère de la Santé Publique du Cameroun. Stratégie nationale d’extension de l’assurance maladie communautaire au Cameroun. Yaoundé: MINSANTE; 2006.
13. Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health. 2005;10(8):799–811.
14. De Allegri M, Sauerborn R, Kouyaté B, Flessa S. Community health insurance in Africa: What are the prospects? Health Policy. 2009;89(1):2–11.
15. Dror DM, Preker AS. Social Reinsurance: A New Approach to Sustainable Community Health Financing. Washington, DC: World Bank Publications; 2002.
16. Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004;19(5):249–70.
17. Atim C. Contribution of Mutual Health Organizations to Financing, Delivery, and Access to Health Care: Synthesis of Research in Nine West and Central African Countries. Partnerships for Health Reform, Technical Report No. 18. 1998.
18. Spiegel DA, Abdullah F, Price RR, Gosselin RA, Bickler SW. World Health Organization Global Initiative for Emergency and Essential Surgical Care: 2008 and beyond. World J Surg. 2009;33(5):920–5.
19. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385:S11.
20. Chou YJ, Pu C, Lee CH, Huang N, Chou LF, Chang HJ. Do physicians in Taiwan encourage hospice care for patients with terminal cancer? J Palliat Med. 2011;14(7):791–6.
21. Chen B, Cheng X, Chen Y. The impact of health insurance on mortality: evidence from a sample of cancer patients in China. J Health Econ. 2007;26(3):479–92.
22. Shen YC, McFeeters J. Out-of-pocket health spending between low-income and high-income populations: who is at risk of exceeding 5% of disposable income? Health Affairs. 2007;25(1):217–26