Exploring the determinants of distress health financing in Cambodia

Abstract

Borrowing is a common coping strategy for households to meet healthcare costs in countries where social health protection is limited or non-existent. Borrowing with interest, hereinafter termed distress health financing or distress financing, can push households into heavy indebtedness and exacerbate the financial consequences of healthcare costs. We investigated distress health financing practices and associated factors among Cambodian households, using primary data from a nationally representative household survey of 5000 households. Multivariate logistic regression was used to determine factors associated with distress health financing. Results showed that 28.1% of households consuming healthcare borrowed to pay for that healthcare with 55% of these subjected to distress financing. The median loan was US$125 (US$200 for loans with interest and US$75 for loans without interest). Approximately 50.6% of healthcare-related loans were to pay for the costs of outpatient care in the past month, 45.8% for inpatient care and 3.6% for preventive care in the past 12 months. While the average period to pay off the loan was 8 months, 78% of households were still indebted from loans taken over 12 months before the survey. Distress financing is strongly associated with household poverty—the poorer the household the more likely it is to borrow, fall into debt and unable to pay off the debt—even for members of the health equity funds, a national scheme designed to improve financial access to health services for the poor. Other determinants of distress financing were household size, use of inpatient care and outpatient consultations with private providers or with both private and public providers. In order to ensure effective financial risk protection, Cambodia should establish a more comprehensive and effective social health protection scheme that provides maximum population coverage and prioritizes services for populations at risk of distress financing, especially poorer and larger households.

The inequalities and determinants of Households’ Distress Financing on Out-off-Pocket Health expenditure in Malaysia

“…Borrowing is a much more common source of healthcare financing among low-and middle-income countries. However, the prevalence shown in this study was relatively low compared to other countries such as India and Cambodia, of which the prevalence was around 42.2% and 22.5% respectively [19,48]. The low prevalence of distress financing in Malaysia is aligned with the healthcare financing system in Malaysia, which is mainly tax-based.…”

“…Notwithstanding the above, the prevalence of borrowing without interest at 13.86% in this current study is almost similar to Cambodia, with 20.8% and 10.9% in 2009 and 2014, respectively [19]. However, the prevalence of borrowing with interest in this current study (1.03%) is much lower compared to Cambodia (69.9%) [19]. Hence, explains the occurrence of inequality among those who borrow with interest.…”

“…For example, in Southeast India, the ability of a poor household to access borrowing with a low-interest rate depends on their social networks [64]. Notwithstanding the above, the prevalence of borrowing without interest at 13.86% in this current study is almost similar to Cambodia, with 20.8% and 10.9% in 2009 and 2014, respectively [19]. However, the prevalence of borrowing with interest in this current study (1.03%) is much lower compared to Cambodia (69.9%) [19].…”

“…Studies on the determinants of distress health financing were relatively limited. Past studies found that distress financing is determined by the household's socio-economic status, household size, and the use of inpatient and outpatient care, especially in the private health sectors [19]. Households in the lower socio-economic group tend to resort to borrowing and often end up unable to pay off their debt [19].…”

“…Past studies found that distress financing is determined by the household's socio-economic status, household size, and the use of inpatient and outpatient care, especially in the private health sectors [19]. Households in the lower socio-economic group tend to resort to borrowing and often end up unable to pay off their debt [19]. Besides, borrowing was also common among those with bigger household sizes and higher health expenses [8].…”