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Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure
International Journal of Health Economics and Policy
Volume 4, Issue 4, December 2019, Pages: 122-131
Received: Sep. 26, 2019; Accepted: Oct. 23, 2019; Published: Oct. 30, 2019
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Robert John Kolesar, The Palladium Group/Health Policy Plus, Phnom Penh, Cambodia; General Secretariat of the National Social Protection Council, Ministry of Economy and Finance, Phnom Penh, Cambodia; Centre d’Etudes et Recherche sur le Développement International (CERDI), Université Clermont Auvergne, Clermont-Ferrand, France
Sambo Pheakdey, General Secretariat of the National Social Protection Council, Ministry of Economy and Finance, Phnom Penh, Cambodia
Bart Jacobs, Deutsche Gesellschaft Fuer Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia; Social Health Protection Network, Bonn, Germany
Rebecca Ross, The Palladium Group, Washington D.C., United States
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To inform efforts to improve Cambodia’s social health protection system and advance universal health coverage, health care-seeking and out-of-pocket expenditure (OOPE) were assessed using the 2016 Cambodia Socioeconomic Survey data. This study focuses on the poorest wealth quintile who reside in rural areas- the primary target population of Cambodia’s largest social health protection scheme, the Health Equity Fund (HEF). The study also estimates the proportion of poor with an Equity card which provides access to HEF benefits at public facilities. Overall, 76% of people who sought healthcare in the past 30 days went to private providers, paying, on average, US$39.43 for treatment. About 18% of patients first sought care from public facilities, paying, on average, US$38.15. Though HEF aims to provide free healthcare for the rural poor, this analysis found that 67.2% of such patients seeking first care at public health facilities pay, on average, US$11.61 after controlling for confounding factors. However, treatment expenditure among the rural poor is about 52% less compared to third wealth quintile patients (p<0.01). About 36% of people under the national poverty line do not hold an Equity card to access HEF benefits. Thus, we conclude that HEF is not yet fully reaching its intended impact of removing OOPE as a barrier to access among the poor. Finally, free access to healthcare should incentivize utilization of public services; however, this study was unable to isolate such an effect among patients from the poorest wealth quintile. Access to healthcare can be strengthened with policy directives focused on further reducing OOPE and addressing other challenges to improve patient demand for public services such as quality of care. Enrollment exclusion errors should be corrected by relaxing the eligibility criteria with population coverage expansion. In addition, health service access should be systematically monitored by integrating service utilization, OOPE, and quality indicators into national monitoring and evaluation systems.
Universal Health Coverage, Social Health Protection, Out-of-Pocket Expenditure, Social Protection Policy, Cambodia, Vulnerability, Rural Poor
To cite this article
Robert John Kolesar, Sambo Pheakdey, Bart Jacobs, Rebecca Ross, Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure, International Journal of Health Economics and Policy. Vol. 4, No. 4, 2019, pp. 122-131. doi: 10.11648/j.hep.20190404.12
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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