Exploring patient and provider perspectives on health insurance effectiveness in cameroon: a qualitative study

Background The global push to achieve universal health coverage (UHC) by 2030 has gained widespread attention, with many countries, including low- and middle-income nations like Cameroon, striving to implement reforms. However, financial, infrastructural, and systemic barriers make achieving UHC in Cameroon challenging. In pursuit of this goal, health insurance systems, particularly private health insurance, have been increasingly promoted to reduce out-of-pocket health expenses. However, the key question remains whether patients receive value for their money. This study aimed to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon, with a focus on awareness, satisfaction, and the challenges influencing its accessibility and functionality. Method Following ethical approvals, this study employed a qualitative exploratory design, using key informant interviews (KII) to examine the perspectives of patients and healthcare providers on the effectiveness of health insurance in Cameroon. The study focused on awareness, satisfaction, and challenges influencing accessibility and functionality. Reflective thematic analysis was used to identify important aspects of our study. Result To ensure that the identified themes accurately represented the data and remained distinct, they were systematically reviewed and refined. This process resulted in five main themes: (1) Accessibility and Quality of Healthcare Services, (2) The Financial Paradox of Health Insurance, (3) Structural and Operational Challenges in the Health Insurance Framework, (4) Information Gaps and Awareness about Health Insurance, and (5) Divergent Experiences and Perspectives on Health Insurance Effectiveness. All participants agreed that health insurance reduces out-of-pocket health costs. Uninsured patients cited high premiums, distrust in the healthcare system, and insufficient knowledge about insurance options as reasons for not enrolling. Insured patients expressed significant dissatisfaction with their insurance packages, particularly with lengthy reimbursement processes and inadequate medical coverage. Conclusion The findings indicate a general agreement on the benefits of health insurance in Cameroon. To improve enrolment and satisfaction, premiums need to be made affordable across all socioeconomic levels, and consider increasing information dissemination and publicity about insurance options. Streamlining reimbursement processes is also crucial.