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The Flipped Break-Even: Re-Balancing Demand- and Supply-Side Financing of Health Centers in Cambodia

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  • Sokunthea Koy

    (Improving Social Protection and Health, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh 120102, Cambodia)

  • Franziska Fuerst

    (Improving Social Protection and Health, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh 120102, Cambodia)

  • Bunnareth Tuot

    (Improving Social Protection and Health, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh 120102, Cambodia)

  • Maurice Starke

    (Improving Social Protection and Health, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh 120102, Cambodia)

  • Steffen Flessa

    (Department of Health Care Management, University of Greifswald, 17487 Greifswald, Germany)

Abstract

Supply-side healthcare financing still dominates healthcare financing in many countries where the government provides line-item budgets for health facilities irrespective of the quantity or quality of services rendered. There is a risk that this approach will reduce the efficiency of services and the value of money for patients. This paper analyzes the situation of public health centers in Cambodia to determine the relevance of supply- and demand-side financing as well as lump sum and performance-based financing. Based on a sample of the provinces of Kampong Thom and Kampot in the year 2019, we determined the income and expenditure of each facility and computed the unit cost with comprehensive step-down costing. Furthermore, the National Quality Enhancement Monitoring Tool (NQEMT) provided us with a quality score for each facility. Finally, we calculated the efficiency as the quotient of quality and cost per service unit as well as correlations between the variables. The results show that the largest share of income was received from supply-side financing, i.e., the government supports the health centers with line-item budgets irrespective of the number of patients and the quality of care. This paper demonstrates that the efficiency of public health centers increases if the relevance of performance-based financing increases. Thus, the authors recommend increasing performance-based financing in Cambodia to improve value-based healthcare. There are several alternatives available to re-balance demand- and supply-side financing, and all of them must be thoroughly analyzed before they are implemented.

Suggested Citation

  • Sokunthea Koy & Franziska Fuerst & Bunnareth Tuot & Maurice Starke & Steffen Flessa, 2023. "The Flipped Break-Even: Re-Balancing Demand- and Supply-Side Financing of Health Centers in Cambodia," IJERPH, MDPI, vol. 20(2), pages 1-20, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:2:p:1228-:d:1030967
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    References listed on IDEAS

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    1. Maryam Bigdeli & Bart Jacobs & Chean Rithy Men & Kristine Nilsen & Wim Van Damme & Bruno Dujardin, 2016. "Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    2. Yusuf Çelik & Mahmud Khan & Neşet Hikmet, 2017. "Achieving value for money in health: a comparative analysis of OECD countries and regional countries," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(4), pages 279-298, October.
    3. Yaman, Kemal, 2014. "Strengths and Weaknesses of Financing Hospitals in Germany," Business and Economics Research Journal, Uludag University, Faculty of Economics and Administrative Sciences, vol. 5(4), pages 1-17, October.
    4. Laura B. Rawlings, 2005. "Evaluating the Impact of Conditional Cash Transfer Programs," The World Bank Research Observer, World Bank, vol. 20(1), pages 29-55.
    5. Robert John Kolesar & Peter Bogetoft & Vanara Chea & Guido Erreygers & Sambo Pheakdey, 2022. "Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia," Health Economics Review, Springer, vol. 12(1), pages 1-20, December.
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