Role of User Benefit Awareness in Health Coverage Utilization among the Poor in Cambodia

ABSTRACT

The objective of this study was to understand the steps to health coverage benefit utilization in Cambodia toward improving access to health care and financial risk protection for the poor. We particularly examine the role of user awareness in the pathway to care seeking and benefit utilization with respect to the Health Equity Funds (HEF). Using 2016 survey data that were nationally representative of households with children under two years of age, we used a series of logistic regression models to evaluate associations between respondents’ awareness of benefits, public health care seeking behaviors, coverage benefit claims, and out-of-pocket expenditures. Beneficiaries were generally aware of their entitlements, although their awareness of specific benefits, such as transport reimbursement, was relatively lower. Awareness of free services at public health centers was associated with twice the odds of having ever visited a public provider for outpatient care, while awareness of free services at public hospitals was associated with higher odds of always seeking inpatient care in the public sector. Study findings point to the decision of where to seek care as the critical point in the pathway to HEF utilization. If the decision had already been made to go to a public provider, it was likely that HEF benefits were claimed. Interventions that prompt appropriate care seeking in the public sector may do the most to improve HEF utilization and subsequently improve access to care through sufficient financial risk protection.

KEYWORDS:

• Cambodia
• health care utilization
• health coverage
• health insurance
• patient awareness

Acknowledgments

We would like to thank Thomas J. Bossert and Stéphane Verguet for their valuable support and feedback during the development of this research as well as Michael Law and Michael R. Reich for their helpful comments on earlier versions of this paper. This research would not have been possible without the work and commitment of the World Bank team for the Global Practice on Health, Nutrition and Population based in Phnom Penh, Cambodia. Data collection activities were supported by the World Bank as part of a larger impact evaluation project.

Contributions Statement

IF and SB conceived of the research question and methodology. SN and SB supported the data collection and oversaw the work. IF conducted analyses and drafted the manuscript. SN and SB reviewed several versions of the manuscript and approved the final manuscript.

Ethical Approval

Ethical approval for this study was received from the Institutional Review Board at the Harvard T.H. Chan School of Public Health (IRB19-0190). Ethical approval for the impact evaluation of H-EQIP was received from the National Ethics Committee for Health Research in Cambodia.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.