Abstract
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.
Highlights
Cambodia is a lower-middle income country with a population of 15.7 million and a gross domestic product (GDP) per capita of $1269 in 2016 (World Bank, 2018b)
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
Cambodia has taken significant strides towards universal health coverage (UHC) but key challenges remain in ensuring that health spending delivers benefits to all Cambodians in accordance with their need for healthcare
Summary
Cambodia is a lower-middle income country with a population of 15.7 million and a gross domestic product (GDP) per capita of $1269 in 2016 (World Bank, 2018b). Gross domestic savings as a proportion of GDP has increased from 6.6% in 2000 to 18% in 2015 (ADB, 2018; World Bank, 2018c) Alongside this sustained economic growth, the health system of Cambodia has seen significant improvements in the last two decades. Maternal mortality has declined from 472 per 100 000 live births in 2005 to 161 per 100 000 in 2015 (National Institute of Statistics et al, 2015; UNDP, 2016). Childhood immunization coverage has expanded with 81% of children aged 12–23 months immunized against measles in 2016 compared with 52% in 2002 This has contributed to a steep decline in infant and under-5 mortality rates, dropping from 45 and 54 per 1000 live births in 2010 to 27 and 35 per 1000, respectively, in 2014 (National Institute of Statistics et al, 2015)
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