Who benefits from healthcare spending in Cambodia? Evidence for a universal health coverage policy

Author:

Asante Augustine D1,Ir Por2,Jacobs Bart2,Supon Limwattananon3,Liverani Marco456,Hayen Andrew7,Jan Stephen89,Wiseman Virginia410

Affiliation:

1. School of Public Health & Community Medicine, University of New South Wales (UNSW) Sydney, Kensington NSW, Australia

2. National Institute of Public Health, Lot no 80, Street 289, Phnom Penh, Cambodia

3. Khon Kaen University, Khon Kaen, Thailand

4. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, UK

5. Faculty of Public Health, Mahidol University, Bangkok, Thailand

6. School of Tropical Medicine and Global Health, Nagasaki University, Japan

7. University of Technology Sydney (UTS), 15 Broadway, Ultimo NSW, Australia

8. The George Institute for Global Health, Newtown, Australia

9. University of New South Wales (UNSW Sydney), Kensington NSW, Australia

10. Kirby Institute for Infections and Immunity, University of New South Wales (UNSW Sydney), Level 6, Wallace Wurth Building, High Street, Kensington NSW, Australia

Abstract

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.

Funder

Deutsche Gesellschaft für Internationale Zusammenarbeit

Social Health Protection Network P4H

Australian Research Council

Publisher

Oxford University Press (OUP)

Subject

Health Policy

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