Abstract
Introduction
To achieve the 2030 vision of becoming an upper-middle-income country, the government of Cambodia prioritizes improving health and well-being through primary health care services toward universal health coverage (UHC). Additionally, the policy ensures that all citizens receive the services they need without financial risk. High out-of-pocket expenditure costs for health care in Cambodia can pose a financial barrier to accessing necessary health care services, such as maternal services, especially for poor and vulnerable people. This study aims to explore the burden of out-of-pocket costs on women who deliver at the National Center for Maternal and Child Health (NMCH), Phnom Penh.
Methods
A cross-sectional study was conducted with 100 women who underwent normal vaginal delivery from January to March 2024. The data were entered and analyzed via Microsoft Excel 2020. Descriptive analysis was performed. The mean or median (IQR) was calculated for continuous variables, and the frequency and percentage were calculated for categorical variables. The results are presented in tables and graphs with detailed explanations.
Results
The women’s mean age was 27 years with ranging from 17 to 40 years. Close to half (48%) of the women were workers, and 57% were from Phnom Penh. Sixty percent of the women had National Social Security Fund (NSSF) cards, 17% had health equity fund (HEF) cards, and 23% did not have any cards. The median total cost of childbirth was 710,000 Riel (IQR = 581,500 Riel). When stratified, it costed 677,500 Riel for women with an NSSF card, 325,000 Riel for women with an HEF card and 1,199,000 Riel for women without a card. Women with NSSF cards and HEF cards did not pay for hospital-funded services, except for a small number, who paid extra fees for beds and gave courtesy fees to the doctors. Women without a card spent approximately 564,000 Riel (IQR = 60,000 riel) out-of-pocket on funded services. The median non-medical expenditure was 619,000 Riel (IQR = 397,000 Riel), of which 659,000 Riel for women with an NSSF card, 325,000 Riel for women with an HEF card, and 576,500 Riel for women without a card. With respect to the resources, 71% were from personal savings, 22% were from relatives’ loans, and 4% were from high-interest loans.
Conclusion
The out-of-pocket expenditure burden associated with childbirth at the NMCH appears to be at a level that poses a financial risk to women and their families. Although the social security health care system and the HEF have helped reduce the overall cost of financing services for women who are members, many still have to pay out-of-pocket, especially for non-medical services, and some are forced to take out-of-pocket loans to cover these costs. For women without a card, there is a cost for both financial and non-medical services. Some recommendations are provided for reducing this out-of-pocket cost burden.