Impact of health financing policies in Cambodia: A 20 year experience

Tim Ensor · Chhun Chhim · Ton Kimsun · Barbara McPake · Ijeoma Edoka

55 citations0/0 files storedSocial Science & Medicine

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Healthcare Systems and Reforms Healthcare Policy and Management Global Health Care Issues

Abstract

Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting. Multiple rounds of the Cambodia Socio-Economic Survey are used to investigate the impact of financing policies on health service utilisation and out of pocket payments both over time using commune panel data from 1997 to 2011 and across groups using individual data from 2004 and 2009. Policy combinations including areas with multiple interventions were examined against controls using difference-in-difference and panel estimation. Widespread roll-out of financing policies combined with user charge formalisation has led to a general reduction in health spending by the poor. Equity funds are associated with a reduction in out of pocket payments although the effect of donor schemes is larger than those financed by government. Vouchers, which are aimed only at reproductive health services, has a more modest impact that is enhanced when combined with other schemes. At the aggregate level changes are less pronounced although there is evidence that policies take a number of years to have substantial effect. Health financing policies and the supportive systems that they require provide a foundation for more radical extension of coverage already envisaged by a proposed social insurance system. A policy challenge is how disparate mechanisms can be integrated to ensure that vulnerable groups remain protected.

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References

2012Does progress towards universal health coverage improve population health?2013Health financing for universal coverage and health system performance: concepts and implications for policy 2011Health-financing reforms in southeast Asia: challenges in achieving universal coverage 2004Out‐of‐pocket health expenditure and debt in poor households: evidence from Cambodia 2006To Retain or Remove User Fees?2003Improving government health services through contract management: a case from Cambodia 2003Access to health care for all? User fees plus a Health Equity Fund in Sotnikum, Cambodia 2007Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia

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2019Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy 2018Equality in financial access to healthcare in Cambodia from 2004 to 2014 2017Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis 2020Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection

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