System-wide analysis of health financing equity in Cambodia: a study protocol

Wiseman, Virginia; Asante, Augustine; Ir, Por; Limwattananon, Supon; Jacobs, Bart; Liverani, Marco; Hayen, Andrew; Jan, Stephen

doi:10.1136/bmjgh-2016-000153

Cited by 8 publications

(9 citation statements)

References 40 publications

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“…The sample was stratified be urban and rural areas in line with the latest inter-census results from 2013 that indicated an urban population of 21.4% of total population, with the capital accounting for 11.8% of the total population (National Institute of Statistics, 2013). More details on the sampling method are provided in the previously published research protocol (Wiseman et al , 2017).…”

Section: Methodsmentioning

confidence: 99%

Exploring the determinants of distress health financing in Cambodia

Jacobs

Asante

et al. 2019

Health Policy and Planning

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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.

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Section: Methodsmentioning

confidence: 99%

Exploring the determinants of distress health financing in Cambodia

Jacobs

Asante

et al. 2019

Health Policy and Planning

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“…The survey was conducted between November 2015 and February 2016 and consisted of a sample of 1000 urban and 4000 rural households. Full details of the sampling procedure are published elsewhere (see Wiseman et al , 2017; http://gh.bmj.com/content/2/1/e000153). The household survey gathered information on utilization of various types of health services including selected preventive healthcare services (family planning services, antenatal care, vaccination services, etc.…”

Section: Methodsmentioning

confidence: 99%

“…Cambodia, like many LMICs, has committed to universal health coverage (UHC) and is implementing reforms to expand access to quality services while maintaining the gains made across the health system over the past years (Wiseman et al , 2017). UHC requires nations to ensure that all citizens have access to the health services they need without the risk of financial hardship (Kutzin, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Over the last decades Cambodia has implemented key health financing reforms designed to promote equity in access to effective and affordable healthcare, especially for the poor. Central among these is the country’s Health Equity Funds (HEFs), a third-party payer mechanism designed to remove financial barriers to accessing public health facilities through reimbursement of fees to facilities for health services rendered to the poor (Jacobs et al , 2007; Ensor et al , 2017; Wiseman et al , 2017). This payer mechanism (the HEF) applies only to the public sector, which comprises 40% of health spending (government plus donor).…”

Section: Introductionmentioning

confidence: 99%

“…The HEF currently covers around 3.2 million Cambodians (about 20% of the population; Ministry of Health, 2016a). Other financing reforms and programmes include internal contracting of health services (Vong et al , 2018), a government midwifery incentive scheme designed to boost facility deliveries (Ir et al , 2015) together with the now redundant voluntary health insurance schemes targeting the informal sector (Annear et al , 2011) and a range of voucher schemes intended to increase the uptake of reproductive and safe motherhood services by poor rural communities (Ensor et al , 2017; Wiseman et al , 2017).…”

Section: Introductionmentioning

confidence: 99%

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Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy

Asante

Jacobs

et al. 2019

Health Policy and Planning

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Cambodia’s healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal. The extent to which the reforms have impacted the poor is not always clear. Using a system-wide approach, this study assesses how benefits from healthcare spending are distributed across socioeconomic groups in Cambodia. Benefit incidence analysis was employed to assess the distribution of benefits from health spending. Primary data on the use of health services and the costs associated with it were collected through a nationally representative cross-sectional survey of 5000 households. Secondary data from the 2012–14 Cambodia National Health Accounts and other official documents were used to estimate the unit costs of services. The results indicate that benefits from health spending at the primary care level in the public sector are distributed in favour of the poor, with about 32% of health centre benefits going to the poorest population quintile. Public hospital outpatient benefits are quite evenly distributed across all wealth quintiles, although the concentration index of −0.058 suggests a moderately pro-poor distribution. Benefits for public hospital inpatient care are substantially pro-poor. The private sector was significantly skewed towards the richest quintile. Relative to health need, the distribution of total benefits in the public sector is pro-poor while the private sector is relatively pro-rich. Looking across the entire health system, health financing in Cambodia appears to benefit the poor more than the rich but a significant proportion of spending remains in the private sector which is largely pro-rich. There is the need for some government regulation of the private sector if Cambodia is to achieve its UHC goals.

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Medical Devices in Low- and Middle-Income Countries

Fleßa¹

2022

Medical Devices

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System-wide analysis of health financing equity in Cambodia: a study protocol

Cited by 8 publications

References 40 publications

Exploring the determinants of distress health financing in Cambodia

Exploring the determinants of distress health financing in Cambodia

Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy

Medical Devices in Low- and Middle-Income Countries

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