By Jean Bruno ESSONO OYONO (Download pdf)
The Contribution of Private Health Insurance to the Financing of Healthcare in Cameroon
By definition, health insurance is part of personal insurance. The purpose of health insurance is to protect the insured against the risks associated with illness, or more precisely, against all events leading to medical intervention.
Elsewhere, in the event that a medical intervention is necessary, the health expenditure linked to this intervention is shared between the patient and the social protection system. However, social security does not have the economic capacity to support and reimburse each individual for all the costs related to their personal consumption of medical care. It covers only a percentage of the medical expenses incurred.
Health insurance has therefore been set up to allow people to take out a contract that will reimburse them for the share of treatment costs not covered by social security. It is therefore intended, as its name suggests, to insure people against the economic consequences of a state of health that requires treatment.
Health insurance is an economic system by which one or more insurers guarantee, after the signature of a contract binding the insurer(s) with a subscriber and according to the conditions appearing in the contract, one or more insured against the financial consequences linked to the occurrence of a harmful event that has damaged the physical integrity of said insured(s), and requiring medical intervention to try to restore the claimant(s) to the situation they were in before the occurrence of the claim.
In Cameroon, as elsewhere, private health insurance effectively participates in the financing of healthcare. In the absence of reliable statistics on the cost of health expenditure in Cameroon and of a universal health coverage system, the contribution of private insurance cannot be properly measured. But the data in our possession estimate 27,633,734,505 FCFA in turnover of private insurance operations in Cameroon in the Bodily Accident and Illness Branch in 2020, according to the DNA (National Insurance Department).
Behind this large sum that the private insurance sector only dreams of increasing hides several challenges that prevent private health insurance operations from being deployed, which puts this branch in deficit in the portfolio of insurers. Its maintenance is justified less by the profits that insurers reap from it than by the need to provide this service to customers, a company that also carries other risks that insurers could avoid if they were not interested in the health coverage. These challenges are of several kinds.
Challenges of Health Insurance
- Insurance: An Ancillary and not a Primary Solution
Health insurance is “the means by which low-income families access healthcare,” specifying the existence of two types of health insurance: the public system and the private system.
In the operation of these two insurance systems, the private operators are not intended to cover the entire population, not even the majority, but to complete or supplement public cover by allowing victims to be reimbursed for care left uncovered by public insurance, hence the concept of complementary health insurance used elsewhere.
It emerges from the above that, technically, having only the health insurance coverage offered by private operators poses a fundamental problem; since this cover is optional and selective, the solution it offers in the financing of healthcare in Cameroon will necessarily be reduced, and its effectiveness as well.
Since private health insurance is by nature selective, it unfortunately only concerns those who can and want to pay. Beyond this aspect, the private companies themselves select the people covered and the conditions of this cover. It is a question of not kissing too much in order to guarantee a good technical result. However, to achieve this ambition, private insurance requires reliable information on the risks to be taken.
Insurance companies experience enormous difficulties in significantly increasing their turnover in the health branch and, consequently, their interventions in the financing of healthcare in Cameroon due to the absence of reliable statistics and information on the disease in Cameroon.
In insurance technology, good insurance coverage requires a sound assessment of the loss ratio of the risk to be insured. However, in the area of healthcare, the elements used to assess the risk to be covered by insurers are never available, and when they are, it is erroneous data, sometimes not updated. This state of affairs, which does not favor an exact assessment of the risk by the insurer, exposes the latter to financial inconvenience.
- Lack of a Regulatory and Information Exchange Body
The practice in healthcare coverage operations in Cameroon shows the one-upmanship between insurance companies, some of which do not hesitate to leave the orthodoxy of the technical rules of the trade to have the favors of some clients. The existence of a regulatory body intended to sanction these anti-competitive practices would allow an improvement in the technical results of this branch and, consequently, its growth.
Moreover, the existence of this regulatory body could also compensate for the unavailability of statistics by pooling the various information gleaned by insurance companies.
The motivations of the insurers may well be noble without making them philanthropists. Indeed, even in the field of healthcare, private health insurance professionals absolutely intend to make a profit. As long as private health insurance exists, it will be not only optional but also exclusive. It will always exclude the poorest, those who cannot or do not want to contribute; it will always exclude the most vulnerable and will only be a consumer product of the middle classes and the rich.
This situation, which prevails today in the absence of a universal health coverage system, will always be perpetuated when this system is set up because governments cannot declare health insurance compulsory for all overnight; they will always start with insured salaried employees in the private and public sectors, the adhesion of the latter being facilitated by the fact that the amount of their salary is known.
While the vast majority of the population is already excluded from health insurance due to their low income, the financial factor continues to be a serious handicap in the capacity of private health insurance to finance healthcare in Cameroon. Indeed, under the relevant provisions of the CIMA Code, in particular article 13, which makes the taking effect of the insurance contract subject to the payment of the entire premium by the subscriber of the insurance contract, it is not possible to finance the health insurance premium gradually or progressively. This constraint, which handicaps individuals as much as small businesses, and even large companies, is not likely to favor the density of health insurance operations.
The weak insurance culture that characterizes our society, which penalizes the activities of insurance companies in other branches where the challenges are often not the same as in the healthcare branch, is also a major factor in financing private health insurance of healthcare in Cameroon.
Not only are many reluctant to pay for a hypothetical service even if it turns out to be expensive and essential when it arises, but also, the health coverage offered by insurers is misunderstood by all those involved in the system, both policyholders and service providers, who see it as an illicit opportunity to enrich themselves.
No service costs more than its price once the insurance is concerned, and everyone competes in ingenuity to develop the most unsuspected frauds in order to enjoy more than is necessary, the advantages offered by private health insurance. So many things do not promote the development or the prosperity of the system.
Promoting Health Insurance
- Implementation of Health Micro-Insurance
In developing countries, the existing traditional systems, particularly in terms of financial intermediation and health coverage, have shown their limits resulting, among other things, in the exclusion of populations with low economic power. By way of relay, we are witnessing the emergence of parallel mechanisms all centered on micro-entrepreneurs and poor households, namely micro-finance and micro-insurance. If the first issue has been widely developed for several years, the second has recently aroused growing interest in scientific debates.
Already implemented in West Africa, the policy of cost recovery in the field of health and its corollary, the establishment of fee-based systems for access to primary and secondary care, pertinently raises the question of access to healthcare for a large part of the population.
Micro-insurance can therefore be perceived as having positive impacts in favor of the well-being of poor populations and, consequently, increase the intervention threshold of private health insurance in the financing of healthcare in Cameroon.
- Multiplication of Mutual Insurance Companies
Mutuals are non-profit partnerships that organize solidarity between their members and whose funds come mainly from members’ contributions. They are intended to be non-economic and have a primarily social role.
In terms of healthcare and in the universes that have already devoted universal health coverage, mutual insurance is also called complementary health insurance because it is an insurance contract intervening in addition to or as a substitute for health insurance in order to reduce the rest to be borne by the insurer.
Because insurance is certainly one of the sectors to which access is the least democratized, mutual societies which are a combination of the principles of insurance, participation, and solidarity, can effectively promote equity in the access to health insurance, participation not being envisaged solely from the angle of the financial contribution. The culture of the populations of Cameroon, characterized by a multitude of mutual aid organizations centered on ethnic origin, age groups, and profession, readily lends itself to the development of mutual. Incentive measures should certainly be taken in this direction by the government.
- Promotion of Universal Health Coverage
By universal health coverage, we mean a situation in which all people and all communities benefit from the quality health services they need without encountering financial difficulties.
To achieve universal health coverage, each country must make progress in at least three directions: expanding priority services, including more people, and reducing out-of-pocket payments.
The monitoring of progress toward universal health coverage must focus on two aspects, the first being the population covered, which must be as large as possible, and the second being accessible to everyone and everywhere, to health services of equivalent quality for all and exercised by the competent services.
It emerges from these postulates that the financing of healthcare in Cameroon should first and foremost be a problem of public policy, the only one capable of providing the population with sufficient numbers of doctors, health facilities, and adequate funding mechanisms. Cameroon is on the right track in view of the well-advanced reflections on the subject. We remain hopeful to have positive results.
Despite imperfections and difficulties of all kinds, the contribution of private health insurance to the financing of healthcare is real. Although marginal, it could increase in quantity and quality, provided that all actors, in particular the State, fully play their role by reorganizing the architecture of healthcare and the promotion of incentive measures. This will encourage and increase the number of players likely to have a notable impact in the sector, such as micro health insurance and mutual health insurance.
By completing the implementation of universal health coverage, the private health insurer, a companion if ever there was one, will then be at ease for more increased and more efficient financing of healthcare in Cameroon.