Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Kolesar, Robert John; Pheakdey, Sambo; Jacobs, Bart; Phay, Sokchegn

doi:10.1016/j.jpolmod.2020.04.009

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Cambodia's health service coverage is at the regional average (Figure 4). The existing health coverage schemes collectively cover about 4.7 million Cambodians, or 30 percent of the population (Figure 5), of which HEF covers about 2.6 million individuals and the national social security fund (NSSF)'s health insurance schemes for civil servants and formally employed workers cover 0.4 million and 1.7 million people, respectively (Kolesar et al, 2021).…”

Section: Universal Health Coverage (Uhc)mentioning

confidence: 99%

Cambodia

2022

IMF Staff Country Reports

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Under Article IV of the IMF's Articles of Agreement, the IMF holds bilateral discussions with members, usually every year. In the context of the 2022 Article IV consultation with Cambodia, the following documents have been released and are included in this package:• A Press Release summarizing the views of the Executive Board as expressed during its November 23, 2022, consideration of the staff report that concluded the Article IV consultation with Cambodia.• The Staff Report prepared by a staff team of the IMF for the Executive Board's consideration on November 23, 2022, following discussions that ended on September 20, 2022, with the officials of Cambodia on economic developments and policies. Based on information available at the time of these discussions, the staff report was completed on November 8, 2022.• An Informational Annex prepared by the IMF staff.• A Debt Sustainability Analysis prepared by the staffs of the IMF and the World Bank.

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Section: Universal Health Coverage (Uhc)mentioning

confidence: 99%

Cambodia

2022

IMF Staff Country Reports

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“…This scheme is complemented by the National Social Security Fund (NSSF) which provides social health insurance to registered private sector workers, civil servants, and some selected populations [ 33 ]. By the end of 2020, these schemes collectively covered approximately 30% of the population [ 34 ]. They serve as the foundational elements for Cambodia to achieve financial risk protection and universal health coverage.…”

Section: Introductionmentioning

confidence: 99%

Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia

Kolesar,

Erreygers,

Van Damme

et al. 2023

Int J Equity Health

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Background Financial risk protection is a core dimension of universal health coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. Increasing indebtedness and high interest rates, particularly among unregulated money lenders, can lead to a vicious cycle of poverty and exacerbate inequity. Methods To inform efforts to improve Cambodia’s social health protection system we analyze 2019–2020 Cambodia Socio-economic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. In addition, we calculate a direct economic measure to facilitate the regular monitoring and reporting on the devastating burden of excessive out-of-pocket expenditure for policy makers. Results More than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to US$ 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is US$ 250.8 million or 0.9% of GDP. Conclusions Such losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders. These measures could strengthen social health protection by enhancing financial risk protection, mitigating vulnerability to the devastating economic effects of health shocks, and reducing inequities.

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“…For example, cost data can be used to determine social health insurance reimbursement rates as the system shifts from supply to demand-side financing. Increasing the social health insurance reimbursement would incentivize increased service volume, particularly for priority and cost-effective services, thereby increasing efficiency [20,21]. In addition, cost data can inform budget planning and efficient resource allocation.…”

Section: Introductionmentioning

confidence: 99%

“…However, user-fee reimbursements paid to public health facilities are allocated to pay for staff incentives (60%) and quality improvement (~40%). Thus, social health protection scheme reimbursements are likely insufficient to cover the increased costs related to personnel, medications, and commodities associated with increased utilization when population coverage is expanded [20,21].…”

Section: Introductionmentioning

confidence: 99%

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

John

Bogetoft

Chea³

et al. 2022

Health Econ Rev

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Background Achieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels. Methods This study assesses Cambodia’s public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories. Results Overall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side ‘service space’ to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient. Conclusions Public health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.

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Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Cited by 6 publications

References 21 publications

Cambodia

Cambodia

Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

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