Who benefits from the healthcare spending in Cambodia? Evidence for a universal health coverage policy

Cambodia’s healthcare system has seen significant improvements in the last two decades. Despite
this, access to quality care remains problematic, particularly for poor rural Cambodians. The government
has committed to universal health coverage (UHC) and is reforming the health financing
system to align with this goal. The extent to which the reforms have impacted the poor is not always
clear. Using a system-wide approach, this study assesses how benefits from healthcare
spending are distributed across socioeconomic groups in Cambodia. Benefit incidence analysis
was employed to assess the distribution of benefits from health spending. Primary data on the use
of health services and the costs associated with it were collected through a nationally representative
cross-sectional survey of 5000 households. Secondary data from the 2012–14 Cambodia
National Health Accounts and other official documents were used to estimate the unit costs of services.
The results indicate that benefits from health spending at the primary care level in the public
sector are distributed in favour of the poor, with about 32% of health centre benefits going to the
poorest population quintile. Public hospital outpatient benefits are quite evenly distributed across
all wealth quintiles, although the concentration index of 0.058 suggests a moderately pro-poor
distribution. Benefits for public hospital inpatient care are substantially pro-poor. The private sector
was significantly skewed towards the richest quintile. Relative to health need, the distribution of
total benefits in the public sector is pro-poor while the private sector is relatively pro-rich. Looking
across the entire health system, health financing in Cambodia appears to benefit the poor more
than the rich but a significant proportion of spending remains in the private sector which is largely
pro-rich. There is the need for some government regulation of the private sector if Cambodia is to
achieve its UHC goals.
Keywords: Equity, health financing, universal health coverage, benefit incidence analysis, Cambodia

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