Out-of-pocket health expenditure and fairness in utilization of health care facilities in Cambodia in 2005 and 2010.

Koustuv Dalal,Olatunde Aremu,Gainel Ussatayeva,Animesh Biswas

doi:10.12688/f1000research.12801.1

Abstract

Background: Out-of-pocket (OOP) payments for health care are highly pervasive in several low-and-middle income countries. The Cambodian health system has envisaged massive repositioning of various health care financing to ensure equitable access to health care. This analysis examinescatastrophic, economic, as well as fairness, impacts of OOPhealthcare payments on households in Cambodia over time. Methods: Data from two waves of a nationally representative household survey conducted in Cambodia (CDHS Surveys 2005 and 2010) were utilized. Healthcare utilizations based on economic status were compared during 2005 and 2010. Variables of interests were i) where care was sought and the instances of treatments, i.e. was treatment sought the first, second or third time; (ii) the mode of payment for treatment of the respondent or for any household member due to sickness or injury in the last 30 days prior to the survey period. Lorenz curves were applied to assess the degree of distribution of inequality in OOP expenditures between different income brackets. Results: The findings revealed that there was inequality and unfairness inhealth carepayments, and catastrophic spending is more common among the poor in Cambodia. The majority of people from poorer households experienced economic hardship and have taken to catastrophichealthcare spending through sales of personal possessions. Conclusion: Based on the findings from this analysis, more attention is needed on effective financial protection for Cambodians to promote fairness. The government should increase spending on services being provided at public health care facilities to reduce ever increasing reliance on private sector providers. These approaches would go a long way to reduce the economic burden of care utilization among the poorest.

Highlights

The main goal of a health care system is to have appropriate funding mechanisms for individuals to acquire care for preventive and curative health needs without deepening into poverty
OOP payments constitute a significant component of health spending in most low-and-middle-income countries (LMICs)
This study provides the first detailed trend analysis of catastrophic OOP health expenditure and fairness of healthcare facilities utilization in Cambodia in 2005 and 2010

Summary

Introduction

The main goal of a health care system is to have appropriate funding mechanisms for individuals to acquire care for preventive and curative health needs without deepening into poverty. In spite of the successes of these funding strategies in high income nations, inadequate planning and lack of political will has given rise to non-existence of universal financing mechanisms in low-and-middle-income countries (LMICs). In these countries, many individuals continue to rely on out-of-pocket (OOP) payments each time they access care, and as a result, are not shielded from economic hardship due to huge health care expenditures. The Cambodian health system has envisaged massive repositioning of various health care financing to ensure equitable access to health care This analysis examines catastrophic, economic, as well as fairness, impacts of OOP health care payments on households in Cambodia over time.

Objectives

Methods

Results

Conclusion