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

R. Kolesar, Sambo Pheakdey, Bart Jacobs, R. Ross
{"title":"Healthcare Access Among Cambodia’s Poor: An Econometric Examination of Rural Care-seeking and Out-of-Pocket Expenditure","authors":"R. Kolesar, Sambo Pheakdey, Bart Jacobs, R. Ross","doi":"10.11648/J.HEP.20190404.12","DOIUrl":null,"url":null,"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.","PeriodicalId":213187,"journal":{"name":"International Journal of Health Economics and Policy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2019-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Health Economics and Policy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11648/J.HEP.20190404.12","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 5

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.
柬埔寨穷人获得医疗保健:农村求医和自付费用的计量经济学检验
为了为改善柬埔寨社会健康保护体系和推进全民健康覆盖的努力提供信息,使用2016年柬埔寨社会经济调查数据评估了求诊和自付费用(OOPE)。这项研究的重点是居住在农村地区的最贫穷的五分之一人口——柬埔寨最大的社会健康保护计划——健康公平基金(HEF)的主要目标人口。该研究还估计了拥有公平卡的穷人的比例,这种卡可以在公共设施获得HEF福利。总体而言,在过去30天内寻求医疗保健的人中,76%的人去了私人医疗机构,平均治疗费为39.43美元。约18%的患者首先从公共设施寻求治疗,平均费用为38.15美元。尽管HEF的目标是为农村贫困人口提供免费医疗服务,但该分析发现,在控制混杂因素后,67.2%的此类患者在公共卫生机构寻求首次治疗时平均支付11.61美元。然而,与第三富裕五分之一的患者相比,农村贫困人口的治疗支出约少52% (p<0.01)。大约36%的国家贫困线以下的人没有持有公平卡来获得HEF福利。因此,我们得出的结论是,HEF尚未完全达到其预期的影响,即消除贫困人口获得教育的障碍。最后,免费获得医疗保健应能激励人们利用公共服务;然而,这项研究无法在最贫穷的五分之一的患者中分离出这种影响。可以通过侧重于进一步减少对外开放和应对其他挑战以改善患者对公共服务的需求(如护理质量)的政策指令,加强获得医疗保健的机会。应该通过放宽人口覆盖率扩大的资格标准来纠正排除登记的错误。此外,应通过将服务利用率、OOPE和质量指标纳入国家监测和评价系统,系统地监测卫生服务的可及性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信