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Assessing progress towards universal health coverage in Cambodia : Evidence using survey data from 2009 to 2019

Kaiser, Andrea Hannah LU ; Okorafor, Okore ; Ekman, Björn LU orcid ; Chhim, Srean ; Yem, Sokunthea and Sundewall, Jesper LU (2023) In Social Science and Medicine 321.
Abstract

Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017,... (More)

Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cambodia, Catastrophic health expenditure, Financial protection, Health financing, Impoverishing medical spending, Out-of-pocket medical expenditure, Universal health coverage
in
Social Science and Medicine
volume
321
article number
115792
publisher
Elsevier
external identifiers
  • pmid:36842307
  • scopus:85148684025
ISSN
0277-9536
DOI
10.1016/j.socscimed.2023.115792
language
English
LU publication?
yes
id
cfd268ec-4048-4dd8-be87-1c24c098e814
date added to LUP
2023-03-15 12:27:10
date last changed
2024-06-21 02:16:12
@article{cfd268ec-4048-4dd8-be87-1c24c098e814,
  abstract     = {{<p>Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.</p>}},
  author       = {{Kaiser, Andrea Hannah and Okorafor, Okore and Ekman, Björn and Chhim, Srean and Yem, Sokunthea and Sundewall, Jesper}},
  issn         = {{0277-9536}},
  keywords     = {{Cambodia; Catastrophic health expenditure; Financial protection; Health financing; Impoverishing medical spending; Out-of-pocket medical expenditure; Universal health coverage}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Social Science and Medicine}},
  title        = {{Assessing progress towards universal health coverage in Cambodia : Evidence using survey data from 2009 to 2019}},
  url          = {{http://dx.doi.org/10.1016/j.socscimed.2023.115792}},
  doi          = {{10.1016/j.socscimed.2023.115792}},
  volume       = {{321}},
  year         = {{2023}},
}