Abstract
BackgroundAchieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels.MethodsThis study assesses Cambodia’s public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories.ResultsOverall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side ‘service space’ to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient.ConclusionsPublic health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.
Highlights
Cambodia has committed to advancing universal health coverage (UHC) which requires expanding population coverage under its social health protection schemes
This study aims to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage in Cambodia
The mean population weighted efficiency scores are 1.12 and 1.41; the mean bias-corrected, population weighted scores are 1.34 and 1.73. This suggests that, overall, if the public health system were fully efficient, hospital service output could increase by 34%, and health center service output could increase by 73% with current financing
Summary
Cambodia has committed to advancing universal health coverage (UHC) which requires expanding population coverage under its social health protection schemes. Austerity exacerbates health inequities in countries with weak social protection policies [2]. This study assesses the technical efficiency of Cambodian public health services to quantify the extent to which current health sector supply-side resources can accommodate social health protection expansion. We examine explanatory factors associated with technical efficiency; and, estimate the unit cost of service provision for the major social health insurance reimbursement categories to inform the policy discussion on strategic purchasing and demand-side health financing. To advance UHC progress, countries can focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels. Total effective social health protection coverage equates to about one-third of the total population
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