Abstract
Introduction
Cambodia has been and continues to make significant efforts to develop its healthcare sector, in line with the Rectangular Strategy, aiming for universal health coverage and poverty reduction. Despite remarkable progress in reducing maternal and infant mortality rates, financial barriers remain a major obstacle to accessing healthcare services, particularly due to out-of-pocket (OOP) expenditures, which account for approximately 60% of total health expenditures. This spending poses a financial risk, especially for poor and vulnerable families. Previous studies have shown that most OOP spending is on inpatient and private services. This study aims to understand the burden of direct out-of-pocket spending for pregnant women and their families related to natural childbirth delivery at a provincial referral hospital.
Methods
This was a cross-sectional study conducted to estimate the burden of out-of-pocket spending for pregnant women and their families related to natural childbirth delivery at Chey Chumneas referral hospital in Kandal province. A total of 100 mothers were conveniently selected after they met the inclusion criteria and consented to participate. Data were collected between April and June 2024 before their leave from the hospital for less than 72 hours. We interviewed them with a predesigned questionnaire focused on demographic characteristics, medical and non-medical expenses, funding sources, and satisfaction with services. Descriptive analysis, including the mean (SD), median (IQR), frequency and percentage, was performed in Microsoft Office Excel 2020.
Results
The study revealed that the mean age of the participating women was 28 years (SD = 6.5 years), with 96% being Khmer and 58% being factory workers. Approximately 79% of all participants resided in Kandal province. Approximately 66% of the women had National Social Security Fund (NSSF) cards, 16% had Health Equity Fund (HEF) cards, and 18% paid for services themselves. For nonmedical costs, women with insurance cards spent a median of 630,000 Riels (IQR = 430,000), whereas women without cards spent slightly more, at 843,500 Riels (IQR = 401,000). The main sources of expenses were personal savings, with 68.2% for NSSF users, 25% for HEF users, and 44.4% for uninsured women. The issue of debt was raised, with 22% of participants borrowing money without interest and another 4% borrowing it at high interest rates. Despite some financial challenges, more than 70% of women expressed high levels of satisfaction with the quality of services, staff behavior, and hospital hygiene.
Conclusion
Out-of-pocket spending remains the primary source of payment for childbirth at Chey Chumneas Referral Hospital, even though social health insurance has helped them significantly reduce the financial burden. Nonmedical expenses, especially for supplies and food, continue to be a heavy burden for women in all groups. For poor women, borrowing money at high interest becomes a financial issue at a worrying point that must be addressed. This study highlights the government's efforts and mechanisms to move toward effective universal health coverage and reduce the financial burden on families.