Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia

Abstract

There is a large body of evidence that user fees in the health sector create exclusion. Health equity funds attempt to improve access to health care services for the poorest by paying the provider on their behalf. This paper reviews four hospital-based health equity funds in Cambodia and draws lessons for future operations. It investigates the practical questions of 'who should do what and how'. It presents, in a comparative framework, similarities and differences in objectives, the actors involved, design aspects and functional modalities between the health equity funds. The results of this review are presented along the lines of identification, hospitalization rates and relative costs. The four schemes had a positive impact on the volume of utilization of hospital services by the poorest patients. They now account for 7 to 52% of total hospital use. The utilization of hospitals by paying patients has remained constant in the same period. The comparative review shows that a range of operational arrangements may be adopted to achieve the health equity fund objectives. Our study identifies essential design aspects, and leaves different options open for others.

Barriers to access and the purchasing function of health equity funds: lessons from Cambodia

“…The second phase of our study showed that, depending on the type and location of the facility, up to 28% of HEF-funded patients now using health facilities did not attend public facilities before having an HEF card and that the majority cited financial constraints as the reason. Using a different methodology, this confirms findings by Noirhomme et al 10 and other studies. 6,9,12 These data confirm that the financing role of HEFs addresses the unmet health-care needs of poor families.…”

“…Our study confirmed that HEF patients did not face stigma, were rarely charged unofficial fees (thanks to procedures put in place by HEF schemes) and that HEFs helped to improve overall quality of care. Noirhomme et al 10 confirmed that contracting arrangements adopted by HEF schemes ensure accountability of health-care providers and set quality standards.…”

“…7,8 Several studies in rural and urban settings have demonstrated the positive impact of HEFs on financial access to health services. 6,9,10 The Strategic framework for equity funds, Health equity funds contribute to reducing inequity, increasing access for the poor and building a system of social protection, more so when their purchasing function is fully and effectively managed. Their impact is optimized when a third-party arrangement involved a communitymandated organization active both at facility and community level that engaged in policy dialogue.…”

Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

“…15,16 In addition, at the end of 2007, the government introduced the nationwide Midwife Incentive Scheme, which pays midwives 10 United States dollars (US$) for each live birth they attended in a referral hospital and US$ 15 for each delivery they attended in a health centre, on top of the fee charged to the patient.…”

Health systems strengthening in global and national contexts

“…Other studies also found that identification of HEF fund recipients would have been more successful and effective if done by community members. Such community involvement was found to be feasible and accrues minimal direct costs (Jacobs & Price, 2006;Noirhomme et al, 2007). Specifically, pagoda-managed equity funds resulted to higher community participation, while indigenous community-based organisations resulted to reduced administrative costs (Noirhomme et al, 2007).…”