By DONGMO Nicaise Flore (Download pdf version)
Pricing of medical acts in Cameroon: Remarks on a Prejudicial Cacophony
The pricing of medical procedures refers to the amount set by the Ministry of Public Health for all services provided by health facilities, whether they are performed by doctors or paramedical professionals. The tariff is a table of prices for products or services. The issue of pricing medical procedures is a topical one in Cameroon. Indeed, the public hospital service is partially financed by the State, while some costs are left to the patient. For example, free routine HIV testing for pregnant women and adolescents from 2016 has been extended to all segments of the population since 1 January 2020. However, many patients still pay for HIV testing in some private health facilities.
Despite regulations on the pricing of medical procedures, there are some discrepancies between public and private hospitals. This is the case in some district hospitals where a vaginal delivery costs between CFAF 20,000 and CFAF 40,000, whereas it costs CFAF 15,000 in a health center. The same vaginal delivery in a clinic costs between CFAF 30,000 and CFAF 150,000 in a private clinic.
How can we understand the variability of medical fees in Cameroonian hospitals? The interest of this reflection lies in the redefinition of the pricing policy for medical procedures in the sense that the arbitrary setting of prices by health facility managers can hurt access to and quality of care. It is therefore interesting to take stock of the pricing of medical procedures in Cameroon while clarifying the content of the texts and their application in terms of the pricing of medical procedures.
State of play of the pricing of medical procedures
The pricing of medical procedures differs according to the category of health facility. When comparing the prices of 1st category hospitals with those of 4th and 5th category health facilities, the prices are variable as shown in the table below:
Comparative table of prices for medical procedures by type of health facility
|Categories of medical procedures||Prices in the FOSAS (4th and 5th categories)||Price at the Yaoundé Gynecological Obstetrics Hospital|
|General consultation||600F for certain public structures and 1500F for private FOSAS||1500 F|
|Observation in the common room|| 1,000F for some facilities and 500 F for others. In addition, others charge a flat rate of 1,000F||4,000F for the common room and 10,000 F for observation in the VIP room|
|Placement of the urinary catheter||2,500F in some public hospitals and 5,000 F in private FOSAS||5 000 F|
|Cesarean section kit||80,000F in public health facilities and 250,000 F in some private FOSAS||200 000 F|
|Delivery kit||15,000F in public health facilities||30 000 F|
|Single-plane suture||3 000 F||6 500F|
|Simple dressing||500F||1 000F|
Source: Yaoundé gynecological-obstetric and pediatric hospital website and survey of certain 4th and 5th category health facilities
In legal terms, article 3 of decree n°63-DF-141 of 24 April 1963 fixed the rates for consultations, delivery visits, medical certificates, and the value of letters, the reduced consultation costs 150F and the full rate 600 F, while consultations at night, on Sundays and public holidays cost 225 F at the reduced rate. Because they are out of step with the difficult socio-economic context, where the guaranteed minimum wage is 36,250 francs, the prices set by the texts in force are no longer applied by most health facilities, which justifies the disparity observed in the health facilities.
Justification of the drifts observed in the pricing of medical procedures
There are three categories of drift observed in the pricing of medical procedures.
Firstly, the harmonization of the costs of medical procedures in health facilities remains problematic, as pricing requires rigor in the provision of medical information. This step conditions the application of a tariff that correctly remunerates the services provided. The age of the text setting the prices of medical acts is a stumbling block in their normal execution in the sense that the socio-economic context has evolved a lot, particularly about the price of medical equipment and medical consumables.
Secondly, as hospitals are confronted with operating difficulties linked to the lack of resources, the pricing of procedures is not strictly controlled and there is a lack of control in health facilities about the price of medical procedures. In addition, some managers of clandestine health facilities are largely responsible for the cacophony, as the prices they charge are far from those applied in public health facilities.
Finally, we can mention the inequality of status between public and private hospitals because public hospitals are subsidized and benefit from certain advantages, unlike private hospitals which are subject to incompressible charges.
Re-establishing orthodoxy in the pricing of medical acts
The revision of the text that sets the tariffs is crucial, as it is no longer adapted to today’s society. In the same way, the reinforcement and control at different levels of the health pyramid, notably at the peripheral, intermediate, and central levels are imperative. Finally, the equitable allocation of subsidies to the public and private sectors would make it possible to avoid the disparity in the pricing of medical acts.
To encourage the changes necessary to respect the approved tariffs set by the supervisory authority, it is essential to take the human factor into account. The following recommendations can be made:
To the Ministry of Public Health
– To step up the fight against clandestine health facilities;
– Establish a health financing fund for all health facilities;
– Set up a committee responsible for revising and updating the texts on the pricing of medical acts;
– Monitor the application of these prices at least monthly;
– Establish a committee at all levels of the health pyramid responsible for the application of the texts;
– Accelerate the universal health coverage project to avoid this cacophony;
– Instruct the Performance Based Financing (PBF) partner to draw up a verification sheet for the various procedures carried out in the health facility, in addition to the community survey which already evaluates the costs of the health facility through the patients received.
To the town halls
– Conduct a monthly audit of each health facility under their jurisdiction;
– Carry out an independent community survey;
– To health facility managers;
– Apply the prices approved and displayed in the health facilities by the Minsanté;
– Display the price list of medical procedures for the use of patients;
– Define the patient circuit and the billing circuit to avoid parallel billing;
– Establish and apply the separation of functions in the health facilities;
– Organize monthly budget monitoring meetings as recommended by the PBF.
– Read and respect the prices posted for medical procedures;
– demand a receipt for the payment of any medical procedure;
– Avoid being treated in non-approved health facilities.