The Impact of the COVID-19 Outbreak on Health Equity Fund Service Utilization among Poor People in National Hospitals in Cambodia.


Health equity fund
Medical services
Service utilization
National hospitals



Cambodia has established the reduction of poverty, vulnerability, and inequality as explicit policy goals in its National Social Protection Policy Framework 2016-2025. It aims to improve and expand existing social health protection schemes to achieve UHC. The Health Equity Fund (HEF) is the national social health protection system for the poor that purchases medical services from public health facilities on behalf of the poor, covering the medical expenses and associated costs. Due to COVID-19, healthcare delivery systems and healthcare utilization have dropped significantly globally. In Cambodia, there is a lack of scientific information about the impact of the COVID-19 outbreak on HEF utilization among poor people. Therefore, we aimed to examine the impact of the COVID-19 outbreak on HEF utilization among poor people in national hospitals in Cambodia.


We used secondary data that were accessible from the patient management and registration system (PMRS) from 6 national hospitals. This study population included patients who visited national hospitals covered by the HEF from 2019 (January to December before COVID-19) to 2020 (January to December, during COVID-19). Service utilization was categorized into 5 main components: OPD, IPD, delivery, emergency and surgery. Descriptive analysis was used to present key characteristics. Bivariate analysis was used to compare key medical services among the poor people’s utilization of national hospitals before and during the COVID-19 outbreak.


Among 287,999 poor patients who used medical services in the six hospitals via HEF from 2019 to 2020, most were women (58.3%), aged between 40-59 years old (33.2%) and from rural residence (98.5%). Service use was commonly OPD (74.9%), followed by IPD (13.4%), emergency (6.6%), surgery (4.1%) and delivery (1.0%). Overall, HEF service utilization in the six national hospitals was not significantly different before (2019) and during the COVID-19 outbreak (2020), with p value = 0.159, although a significant decline in service utilization was observed in the general population, p value = 0.007.


In conclusion, the findings showed that the COVID-19 outbreak had a non-significant impact on HEF service utilization in national hospitals during the early period of the outbreak. There were no specific population groups that suffered from health service disruption during the early COVID-19 outbreak among the poor in Cambodia. Further assessment to confirm the impact on HEF service utilization among the poor during the mature stage of COVID-19 pandemic is needed.