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Financial protection of patients through compensation of providers: The impact of Health Equity Funds in Cambodia

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  • Flores, Gabriela
  • Ir, Por
  • Men, Chean R.
  • O’Donnell, Owen
  • van Doorslaer, Eddy

Abstract

Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs over time in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount paid by 35%, on average. The effect is larger for households that are poorer and mainly use public health care. Reimbursement of providers through a government operated scheme also reduces household OOP payments but the effect is not as well targeted on the poor. Both compensation models raise household non-medical consumption but have no impact on health-related debt. HEFs reduce the probability of primarily seeking care in the private sector.

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  • Flores, Gabriela & Ir, Por & Men, Chean R. & O’Donnell, Owen & van Doorslaer, Eddy, 2013. "Financial protection of patients through compensation of providers: The impact of Health Equity Funds in Cambodia," Journal of Health Economics, Elsevier, vol. 32(6), pages 1180-1193.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1180-1193
    DOI: 10.1016/j.jhealeco.2013.09.012
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    Cited by:

    1. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    2. Robert John Kolesar & Guido Erreygers & Wim van Dam & Vanara Chea & Theany Choeurng & Soklong Leng, 2021. "Hardship Financing, Productivity Loss, and the Economic Cost of Illness and Injury in Cambodia," Working Papers hal-03437399, HAL.
    3. Osmani, Ahmad Reshad & Okunade, Albert, 2021. "A Double-Hurdle Model of Healthcare Expenditures across Income Quintiles and Family Size: New Insights from a household Survey," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 14(6), pages 246-246.
    4. Yvonne Beaugé & Manuela De Allegri & Samiratou Ouédraogo & Emmanuel Bonnet & Naasegnibe Kuunibe & Valéry Ridde, 2020. "Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso," IJERPH, MDPI, vol. 17(18), pages 1-21, September.
    5. Supon Limwattananon & Sven Neelsen & Owen O'Donnell & Phusit Prakongsai & Viroj Tangcharoensathien & Eddy van Doorslaer & Vuthiphan Vongmongkol, 2013. "Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand," CESifo Working Paper Series 4262, CESifo.
    6. Wagner, Natascha & Quimbo, Stella & Shimkhada, Riti & Peabody, John, 2018. "Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines," Social Science & Medicine, Elsevier, vol. 204(C), pages 51-58.
    7. Ellen Van de Poel & Gabriela Flores & Por Ir & Owen O'Donnell, 2016. "Impact of Performance‐Based Financing in a Low‐Resource Setting: A Decade of Experience in Cambodia," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 688-705, June.
    8. Tim Kelsall & Seiha Heng, 2014. "The political economy of inclusive healthcare in Cambodia Guarantee Scheme in India," Global Development Institute Working Paper Series esid-043-14, GDI, The University of Manchester.
    9. Wagstaff, Adam & Eozenou, Patrick Hoang-Vu, 2014. "CATA meets IMPOV: a unified approach to measuring financial protection in health," Policy Research Working Paper Series 6861, The World Bank.
    10. Ensor, Tim & Chhun, Chhim & Kimsun, Ton & McPake, Barbara & Edoka, Ijeoma, 2017. "Impact of health financing policies in Cambodia: A 20 year experience," Social Science & Medicine, Elsevier, vol. 177(C), pages 118-126.
    11. R.M.N.N. Senavirathna & R.M.N.S. Senavirathna, 2023. "Healthcare Expenditures Across Household Headship and Expenditure Quintiles: Insights From a Household Survey," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 7(3), pages 117-131, March.
    12. Sven Neelsen & Owen O'Donnell, 2017. "Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 179-203, December.
    13. Treleaven, Emily & Ngin, Chanrith, 2021. "When parents are not present: Decision-making dynamics for young children's health and illness in migrant-sending households in rural Cambodia," Social Science & Medicine, Elsevier, vol. 287(C).
    14. World Bank, 2013. "Where Have All the Poor Gone? : Cambodia Poverty Assessment 2013," World Bank Publications - Reports 17546, The World Bank Group.
    15. Annear, Peter Leslie & Ahmed, Shakil & Ros, Chhun Eang & Ir, Por, 2013. "Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia," Social Science & Medicine, Elsevier, vol. 96(C), pages 223-231.
    16. Raphaël Cottin, 2018. "Free health care for the poor: a good way to achieve universal health coverage? Evidence from Morocco," Working Papers DT/2018/16, DIAL (Développement, Institutions et Mondialisation).
    17. Pablo Celhay & Paul Gertler & Paula Giavagnoli & Christel Vermeersch, 2016. "Nudging Medical Providers to Adopt and Sustain Better Quality Care Practices," Natural Field Experiments 00537, The Field Experiments Website.
    18. Rika Idei & Hironori Kato, 2020. "Medical-purposed travel behaviors in rural areas in developing countries: a case study in rural Cambodia," Transportation, Springer, vol. 47(3), pages 1415-1438, June.
    19. Jiannan Li & Bocong Yuan, 2019. "Understanding the effectiveness of government health expenditure in improving health equity: Preliminary evidence from global health expenditure and child mortality rate," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1968-1979, October.

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    More about this item

    Keywords

    Health Financing; User fees; Financial protection; Health care; Cambodia;
    All these keywords.

    JEL classification:

    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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