Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection

Jithitikulchai, Theepakorn; Feldhaus, Isabelle; Bauhoff, Sebastian; Nagpal, Somil

doi:10.1093/heapol/czaa151

Cited by 12 publications

(15 citation statements)

References 32 publications

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“…Previous studies revealed that HEF membership contributed to the health service uptake at public facilities and reduced healthcare expenditure in general users. 16 27 Our findings extended the understanding that HEF membership has also increased public healthcare use and substantially reduced healthcare spending among people with T2D and/or HTN. Since HEF benefits are only available in public healthcare facilities, it is not surprising that it also contributes to increasing service uptake in public facilities.…”

Section: Discussionsupporting

confidence: 70%

Healthcare utilization and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Chhim

Buffel

et al. 2022

Preprint

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Objective: To assess utilization of public and private healthcare, related healthcare expenditure, and associated factors for people with type 2 diabetes (T2D) and/or hypertension (HTN) and for people without those conditions in Cambodia. Methods: A cross-sectional household survey. Settings: Five operational districts in Cambodia. Participants: Data was from 2,360 participants aged ≥ 40 years who had used healthcare services at least once in the three months preceding the survey. Primary and secondary outcome: The main variables of interest were the number of healthcare visits and healthcare expenditure in the last three months. Results: The majority of healthcare visits took place in the private sector. Only 22.0% of healthcare visits took place in public healthcare facilities: 21.7% in people with HTN, 37.2% in people with T2D, 34.7% in people with T2D plus HTN, and 18.9% in people without the two conditions (P-value<0.01). In people with T2D and/or HTN, increased public healthcare use was significantly associated with Health Equity Fund (HEF) membership and living in operational districts with community-based care. Furthermore, significant healthcare expenditure reduction was associated with HEF membership and using public healthcare facilities in these populations. Conclusion: Overall public healthcare utilization was relatively low; however, it was higher in people with chronic conditions. HEF membership and community-based care contributed to higher public healthcare utilization among people with chronic conditions. Using public healthcare services regardless of HEF status reduced healthcare expenditure, but the reduction in spending was more noticeable in people with HEF membership. To increase public healthcare utilization among people with T2D and/or HTN, the public healthcare system should further improve care quality, expand social health protection, and expand community-based care for this population. However, these may require more time and resources. One potential strategy in the short run is to partner the private sector with the public sector.

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Section: Discussionsupporting

confidence: 70%

Healthcare utilization and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Chhim

Buffel

et al. 2022

Preprint

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“…In the project we studied, the choice was to introduce and implement a HIF, which is a variant of health equity funds (HEFs), where third-party organizations (often NGOs) are responsible for identifying the poorest and financing their access to care. These approaches have been well-documented in Cambodia and the experience has been reported in several publications (9,16,17). It is interesting to note, however, that HEFs have not "gone mainstream."…”

Section: Discussionmentioning

confidence: 94%

Ensuring continuity of care during the COVID-19 pandemic in Guinea: Process evaluation of a health indigent fund

Barry

Kouyaté²,

Sow³

et al. 2022

Front. Public Health

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BackgroundThe emergence of the COVID-19 has disrupted the health and socioeconomic sectors, particularly in resource-poor settings such as Guinea. Like many sub-Saharan countries, Guinea is facing shortcomings related to its fragile health system and is further affected by the passage of the Ebola virus disease. The pandemic has worsened the socio-economic situation of the poorest people, leading to their exclusion from health care. To promote access to care for the most vulnerable populations, a system was set up to provide care for these people who are victims of health marginalization to promote their access to care. This study aimed to analyze access to health services by vulnerable populations during the COVID-19 pandemic in Guinea through the establishment of a health indigent fund (HIF).MethodsThis was a qualitative study to assess the project implementation process. A total of 73 in-depth individual interviews were conducted with beneficiaries, health workers, community health workers and members of the HIF management committee, and a few informal observations and conversions were also conducted in the project intervention areas. The data collected were transcribed and coded using the deductive and inductive approaches with the Nvivo software before applying the thematic analysis.ResultsA total of 1,987 indigents were identified, of which 1,005 were cared for and 64 referred to all 38 intervention health facilities within the framework of the HIF. All participants appreciated the project's social action to promote access to equitable and quality health care for this population excluded from health care services. In addition, the project has generated waves of compassion and solidarity toward these “destitute” people whose main barrier to accessing health care remains extreme poverty. A state of poverty that leads some to sell their assets (food or animal reserves) or to go into debt to ensure access to care for their children, considered the most at risk.ConclusionThe HIF can be seen as an honest attempt to provide better access to health care for the most vulnerable groups. Some challenges need to be addressed including the current system of acquiring funds before the attempt can be considered scalable.

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“…There is mixed evidence as to if the HEF increases public health service utilization due to issues with gaps in financial risk protection, general low utilization of public providers, and deficient eligibility targeting [ 10 ]. However, a direct comparison of utilization rates by service level and type demonstrates that public health service utilization among HEF beneficiaries is generally higher compared to the rest of the population.…”

Section: Discussionmentioning

confidence: 99%

“…For example, systematic factors can lead to patient avoidance of public facilities due to quality perceptions including competency and attitude of providers [ 78 ]. Another factor is limited service availability, particularly for non-communicable diseases [ 10 ]. Moreover, it is also possible that patients may avoid public care-seeking due to unofficial fees or face substantial indirect financial shocks relating to needed medical care and/or lost productivity [ 20] .…”

Section: Discussionmentioning

confidence: 99%

“…A study assessing overall health system technical efficiency in Asia found Cambodia to be among the countries that can improve use of the current resources [ 8 ]. Public sector health expenditure is 47% of Cambodia’s total health expenditure [ 9 ]; however, only about 20% of people with an illness or injury first seek care in the public sector [ 10 ]. A district level efficiency analysis of public health services in five Cambodian provinces found evidence of sub-optimal performance [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection

Cited by 12 publications

References 32 publications

Healthcare utilization and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Healthcare utilization and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Ensuring continuity of care during the COVID-19 pandemic in Guinea: Process evaluation of a health indigent fund

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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