Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses

Abstract

BackgroundOlder people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians’ financial access to health care over time, using nationally representative data to enable the formulation of appropriate responses.MethodsUsing data from three nationally representative household surveys from 2004, 2009 and 2014, we assess key indicators of financial access to health care for households with older people (aged 60 years or older), and compare these with households without older members. For 2014 data, the determinants of catastrophic health expenses at the 10 and 40 % threshold were determined for older people. Data was stratified by age and place of residence (urban/rural), and analysed using Stata statistical software. Sample weights were calibrated to reflect accurate population composition at the time of the survey. Monetary values for 2004 and 2009 were transformed into 2014 values using annual inflation rate figures.ResultsCare-seeking when sick among older people increased considerably from 2004 to 2014, irrespective of gender or place of residence. There were positive trends in the incidence of catastrophic and impoverishing healthcare expenses over the studied time periods. This was also the case for indebtedness. Rural households with older people were considerable more likely to suffer financial hardship due to health-related expenses than their urban equivalents. In 2014, older people spent 50 % more per month on health care than younger people. Determinants of catastrophic health expenditures among households with older people were residing in a rural area, and having a household member with an illness, especially a non-communicable disease.ConclusionIn order to make health care more equitable for older people, efforts should be directed to rural areas. Interventions should include improving management of non-communicable diseases at the primary care level, together with a reconfiguration of social health protection schemes to increase the inclusion of older people.

Assessing Factors Associated with Catastrophic Healthcare Expenditure in Côte d’Ivoire: Evidence from the Household Living Standard Survey 2015

“…Our results show that nearly 1% of households had experienced CHE in the overall sample and 4% of those who had done OOPs. These frequencies are well below those of other low-and middle-income countries [7,[20][21][22][23]. A low incidence of catastrophic payments could reflect the fact that people receive the care they need and are protected from direct payments.…”

The Cost of Healthcare among Malaysian Community-Dwelling Elderly

“…The high cost of cancer treatment leads the elderly to incur higher healthcare costs because as is well known the treatment and medication for cancer is expensive compared to other diseases like hypertension, diabetes mellitus and cardiovascular disease. This situation can also cause the elderly to become trapped into CHE and poverty (Li et al 2012;Minh et al 2013;Li et al 2014); Jacobs et al (2016). Meanwhile, for hypertension, the negative sign at the 1% significance level showed that the disease had a lower impact compared to other diseases against the healthcare costs among the elderly.…”

“…Due to financial hardship, living alone and having specific illnesses which require the utilisation of health care services, the elderly spend more on health expenditure compared to others and face the prospect of catastrophic health expenditure (Jacobs et al 2016;Yang et al 2016;Arsenijevic et al 2016). One study that investigated the socioeconomic and medical correlation of health expenditure among the rural elderly in South India was carried out by Brinda et al (2012).…”

“…From the body of empirical evidence, numerous studies on healthcare costs have shown that households with elderly and chronically ill people are more likely to suffer financial hardship and to be at risk of experiencing the problem of CHE (Yardim et al 2009;Barros et al 2011;Li et al 2012;Minh et al 2013;Li et al 2014;Jacobs et al 2016). There have also been quite a number of studies that have focused on the elderly who have been affected by CHE and its determinants.…”

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations

“…children younger than age five, and seniors aged 60+) were taken directly from 2019 population projections. Elderly are defined as people aged 60+ because there is Cambodia‐specific evidence indicating households with people older than age 59 are very vulnerable to out‐of‐pocket (OOP) health care expenditures (Jacobs, de Groot and Fernandez Antunes, ). Estimates for PLHIV and people with TB were sourced from the World Health Organization Global Health Observatory and the Yale Global Health Review ( YGHR , ), respectively.…”