Abstract

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.

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