Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure

Robert John Kolesar; Sambo Pheakdey; Bart Jacobs; Rebecca Ross

doi:doi:10.11648/j.hep.20190404.12

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Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure

Robert John Kolesar, Sambo Pheakdey, Bart Jacobs, Rebecca Ross

Published in International Journal of Health Economics and Policy (Volume 4, Issue 4)

Received: 26 September 2019 Accepted: 23 October 2019 Published: 30 October 2019

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Abstract

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.

Published in	International Journal of Health Economics and Policy (Volume 4, Issue 4)
DOI	10.11648/j.hep.20190404.12
Page(s)	122-131
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Universal Health Coverage, Social Health Protection, Out-of-Pocket Expenditure, Social Protection Policy, Cambodia, Vulnerability, Rural Poor

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APA Style

Robert John Kolesar, Sambo Pheakdey, Bart Jacobs, Rebecca Ross. (2019). 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, 4(4), 122-131. https://doi.org/10.11648/j.hep.20190404.12

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ACS Style

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. Int. J. Health Econ. Policy 2019, 4(4), 122-131. doi: 10.11648/j.hep.20190404.12

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AMA Style

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. Int J Health Econ Policy. 2019;4(4):122-131. doi: 10.11648/j.hep.20190404.12

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@article{10.11648/j.hep.20190404.12,
  author = {Robert John Kolesar and Sambo Pheakdey and Bart Jacobs and Rebecca Ross},
  title = {Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure},
  journal = {International Journal of Health Economics and Policy},
  volume = {4},
  number = {4},
  pages = {122-131},
  doi = {10.11648/j.hep.20190404.12},
  url = {https://doi.org/10.11648/j.hep.20190404.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20190404.12},
  abstract = {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.},
 year = {2019}
}

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TY  - JOUR
T1  - Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure
AU  - Robert John Kolesar
AU  - Sambo Pheakdey
AU  - Bart Jacobs
AU  - Rebecca Ross
Y1  - 2019/10/30
PY  - 2019
N1  - https://doi.org/10.11648/j.hep.20190404.12
DO  - 10.11648/j.hep.20190404.12
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 122
EP  - 131
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20190404.12
AB  - 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.
VL  - 4
IS  - 4
ER  -

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Author Information

Robert John Kolesar

The Palladium Group/Health Policy Plus, Phnom Penh, Cambodia
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
Rebecca Ross

The Palladium Group, Washington D.C., United States

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Plain Text BibTeX RIS

APA Style

Robert John Kolesar, Sambo Pheakdey, Bart Jacobs, Rebecca Ross. (2019). 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, 4(4), 122-131. https://doi.org/10.11648/j.hep.20190404.12

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ACS Style

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. Int. J. Health Econ. Policy 2019, 4(4), 122-131. doi: 10.11648/j.hep.20190404.12

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AMA Style

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. Int J Health Econ Policy. 2019;4(4):122-131. doi: 10.11648/j.hep.20190404.12

Copy | Download

@article{10.11648/j.hep.20190404.12,
  author = {Robert John Kolesar and Sambo Pheakdey and Bart Jacobs and Rebecca Ross},
  title = {Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure},
  journal = {International Journal of Health Economics and Policy},
  volume = {4},
  number = {4},
  pages = {122-131},
  doi = {10.11648/j.hep.20190404.12},
  url = {https://doi.org/10.11648/j.hep.20190404.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20190404.12},
  abstract = {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.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure
AU  - Robert John Kolesar
AU  - Sambo Pheakdey
AU  - Bart Jacobs
AU  - Rebecca Ross
Y1  - 2019/10/30
PY  - 2019
N1  - https://doi.org/10.11648/j.hep.20190404.12
DO  - 10.11648/j.hep.20190404.12
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 122
EP  - 131
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20190404.12
AB  - 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.
VL  - 4
IS  - 4
ER  -

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