Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-08T08:01:49.516Z Has data issue: false hasContentIssue false

FAIRNESS OF UTILIZING HEALTH CARE FACILITIES AND OUT-OF-POCKET PAYMENT BURDEN: EVIDENCE FROM CAMBODIA

Published online by Cambridge University Press:  10 September 2012

KOUSTUV DALAL
Affiliation:
Department of Public Health Science, School of Health and Medical Science, Örebro University, Örebro, Sweden
OLATUNDE AREMU
Affiliation:
Faculty of Medicine, University of Southampton, UK College of Medicine, University of Ibadan, Nigeria

Summary

Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

Type
Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Annear, P., Bigdeli, M., Ros, C. E. & Jacobs, B. (2008) Providing access to health services for the poor: health equity in Cambodia. In Meessen, B., Pei, X., Criel, B. & Bloom, G. (eds) Health and Social Protection Experiences from Cambodia, China and Lao PDR. Institute of Tropical Medicine, Antwerp.Google Scholar
Aremu, O., Lawoko, S., Moradi, T. & Dalal, K. (2011) Socio-economic determinants in selecting childhood diarrhoea treatment options in sub-Saharan Africa: a multilevel model. Italian Journal of Pediatrics 37, 13.CrossRefGoogle ScholarPubMed
Barber, S., Bonnet, F. & Beckedam, H. (2004) Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia. Health Policy and Planning 19(4), 199208.CrossRefGoogle ScholarPubMed
Berman, P. & Dave, P. (1996) Experiences in paying for health care in India's voluntary sector. International Journal of Health Planning and Management 11(1), 3351.Google ScholarPubMed
Berman, P. & Rose, L. (1996) The role of private providers in maternal and child health and family planning services in developing countries. Health Policy and Planning 11(2), 142155.CrossRefGoogle ScholarPubMed
Biacabe, S. (2009) Integration of Health Financing Strategic Framework and National Programmes Strategic Plans. World Health Organization, Phnom Penh.Google Scholar
Bigdeli, M. & Annear, P. (2009) Barriers to access and the purchasing function of health equity funds: lessons from Cambodia. Bulletin of the World Health Organization 87, 560564.CrossRefGoogle ScholarPubMed
Fabricant, S. J., Kamara, C. W. & Mills, A. (1999) Why the poor pay more: household curative expenditures in rural Sierra Leone. International Journal of Health Planning and Management 14(3), 179199.Google ScholarPubMed
Grundy, J., Khut, Q. Y., Oum, S., Annear, P. & Ky, V. (2009) Health system strengthening in Cambodia – a case study of health policy response to social transition. Health Policy 92(2–3), 107115.CrossRefGoogle ScholarPubMed
Grundy, J. & Moodie, R. (2009) An approach to health system strengthening in the Democratic Peoples Republic of Korea (North Korea). International Journal of Health Planning and Management 24(2), 113129.Google ScholarPubMed
Haines, A., Heath, I. & Smith, R. (2000) Joining together to combat poverty. Everybody welcome and needed. British Medical Journal 320(7226), 12.CrossRefGoogle ScholarPubMed
Kiernan, B. (1996) The Pol Pot Regime. Yale University Press, New Haven and London.Google Scholar
Kruk, M. E., Goldmann, E. & Galea, S. (2009) Borrowing and selling to pay for health care in low- and middle-income countries. Health Affairs 28(4), 10561066.CrossRefGoogle ScholarPubMed
Leive, A. & Xu, K. (2008) Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bulletin of the World Health Organization 86(11), 849856.CrossRefGoogle ScholarPubMed
Limwattananon, S., Tangcharoensathien, V. & Prakongsai, P. (2007) Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization 85(8), 600606.CrossRefGoogle ScholarPubMed
Macro ORC (2005) Cambodia Demographic and Health Surveys. URL: www.measuredhs.com/publications/publication-FR185-DHS-Final-Reports.cfmGoogle Scholar
Meessen, B., Bigdeli, M., Chheng, K., Decoster, K., Ir, P., Men, C.et al. (2011) Composition of pluralistic health systems: how much can we learn from household surveys? An exploration in Cambodia. Health Policy and Planning 26 (Supplement 1), i3044.CrossRefGoogle ScholarPubMed
Nakahara, S., Saint, S., Sann, S., Ichikawa, M., Kimura, A., Eng, L.et al. (2010) Exploring referral systems for injured patients in low-income countries: a case study from Cambodia. Health Policy and Planning 25(4), 319327.CrossRefGoogle ScholarPubMed
O'Donnell, O., van Doorslaer, E., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Akkazieva, B.et al. (2008) Who pays for health care in Asia? Journal of Health Economics 27(2), 460475.CrossRefGoogle ScholarPubMed
Onwujekwe, O., Hanson, K., Uzochukwu, B., Ichoku, H., Ike, E. & Onwughalu, B. (2010a) Are malaria treatment expenditures catastrophic to different socio-economic and geographic groups and how do they cope with payment? A study in southeast Nigeria. Tropical Medicine and International Health 15(1), 1825.Google ScholarPubMed
Onwujekwe, O. E., Uzochukwu, B. S., Obikeze, E. N., Okoronkwo, I., Ochonma, O. G., Onoka, C. A.et al. (2010b) Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria. BMC Health Service Research 10, 67.CrossRefGoogle ScholarPubMed
Opwora, A. S., Laving, A. M., Nyabola, L. O. & Olenja, J. M. (2011) Who is to blame? Perspectives of caregivers on barriers to accessing healthcare for the under-fives in Butere District, Western Kenya. BMC Public Health 11, 272.CrossRefGoogle ScholarPubMed
Pannarunothai, S. & Mills, A. (1997) The poor pay more: health-related inequality in Thailand. Social Science & Medicine 44(12), 17811790.CrossRefGoogle ScholarPubMed
Skarbinski, J., Walker, H. K., Baker, L. C., Kobaladze, A., Kirtava, Z. & Raffin, T. A. (2002) The burden of out-of-pocket payments for health care in Tbilisi, Republic of Georgia. Journal of the American Medical Association 287(8), 10431049.CrossRefGoogle ScholarPubMed
Soeung, S., Grundy, J., Kamara, L., McArthur, A. & Samnang, C. (2007) Developments in immunization planning in Cambodia – rethinking the culture and organization of national program planning. Rural Remote Health 7(2), 630.Google ScholarPubMed
Subramanian, S. V., Delgado, I., Jadue, L., Vega, J. & Kawachi, I. (2003) Income inequality and health: multilevel analysis of Chilean communities. Journal of Epidemiology and Community Health 57(11), 844848.CrossRefGoogle ScholarPubMed
Subramanian, S. V. & Kawachi, I. (2003) The association between state income inequality and worse health is not confounded by race. International Journal of Epidemiology 32(6), 10221028.CrossRefGoogle Scholar
Subramanian, S. V. & Kawachi, I. (2004) Income inequality and health: what have we learned so far? Epidemiological Review 26, 7891.CrossRefGoogle ScholarPubMed
Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K.et al. (2011) Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet 377(9768), 863873.CrossRefGoogle ScholarPubMed
Thuan, N. T., Lofgren, C., Chuc, N. T., Janlert, U. & Lindholm, L. (2006) Household out-of-pocket payments for illness: evidence from Vietnam. BMC Public Health 6, 283.CrossRefGoogle ScholarPubMed
Tin, N., Lwin, S., Kyaing, N. N., Htay, T. T., Grundy, J., Skold, M.et al. (2010) An approach to health system strengthening in the Union of Myanmar. Health Policy 95(2–3), 95102.CrossRefGoogle ScholarPubMed
Touch, S., Grundy, J., Hills, S., Rani, M., Samnang, C., Khalakdina, A.et al. (2009) The rationale for integrated childhood meningoencephalitis surveillance: a case study from Cambodia. Bulletin of the World Health Organization 87(4), 320324.CrossRefGoogle ScholarPubMed
Uzochukwu, B. S. & Onwujekwe, O. E. (2004) Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: a case study of four local government areas operating the Bamako initiative programme in south-east Nigeria. International Journal of Equity in Health 3(1), 6.CrossRefGoogle ScholarPubMed
Vyas, S. & Kumaranayake, L. (2006) Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning 21(6), 459468.CrossRefGoogle ScholarPubMed
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J. & Murray, C. J. (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362(9378), 111117.CrossRefGoogle ScholarPubMed