Exploring the determinants of distress health financing in Cambodia

Bibliographic Data

ID11490992
AuthorsPor Ir (0000-0003-3493-2749, National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia, corresponding author), Bart Jacobs (0000-0003-0075-6732, Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Lot No. 80, Street 289, Phnom Penh, Cambodia), Augustine Asante (0000-0003-3894-3437, UNSW Sydney), Augustine D Asante (UNSW Sydney), Marco Liverani (0000-0003-0829-291X, London School of Hygiene & Tropical Medicine), Jan (0000-0003-2839-1405, UNSW Sydney), Stephen Jan (The George Institute for Global Health, University of New South Wales, 1 King St Newtown, New South Wales, Australia), Srean Chhim (0000-0003-1558-1875, National Institute of Public Health, Lot No. 80, Street 289, Phnom Penh, Cambodia), Virginia Wiseman (0000-0002-7911-0741, London School of Hygiene & Tropical Medicine)
Year2019
Volume34
IssueSupplement_1
Pagesi26-i37
Publication date2019-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czz006
PMID31644799
OpenAlexW2981640539
LanguageEN
Citations received12
References cited79

Borrowing is a common coping strategy for households to meet healthcare costs in countries where social health protection is limited or non-existent. Borrowing with interest, hereinafter termed distress health financing or distress financing, can push households into heavy indebtedness and exacerbate the financial consequences of healthcare costs. We investigated distress health financing practices and associated factors among Cambodian households, using primary data from a nationally representative household survey of 5000 households. Multivariate logistic regression was used to determine factors associated with distress health financing. Results showed that 28.1% of households consuming healthcare borrowed to pay for that healthcare with 55% of these subjected to distress financing. The median loan was US$125 (US$200 for loans with interest and US$75 for loans without interest). Approximately 50.6% of healthcare-related loans were to pay for the costs of outpatient care in the past month, 45.8% for inpatient care and 3.6% for preventive care in the past 12 months. While the average period to pay off the loan was 8 months, 78% of households were still indebted from loans taken over 12 months before the survey. Distress financing is strongly associated with household poverty—the poorer the household the more likely it is to borrow, fall into debt and unable to pay off the debt—even for members of the health equity funds, a national scheme designed to improve financial access to health services for the poor. Other determinants of distress financing were household size, use of inpatient care and outpatient consultations with private providers or with both private and public providers. In order to ensure effective financial risk protection, Cambodia should establish a more comprehensive and effective social health protection scheme that provides maximum population coverage and prioritizes services for populations at risk of distress financing, especially poorer and larger households

Business · Developing country · Distress · Economic growth · Economics · Health care · Social determinants of health · Finance · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine