Subsidised exemption schemes

Access to health care for all? User fees plus a health equity fund in Sotnikum, Cambodia is one of the few documented examples of a successful subsidised exemption scheme. The Health Equity Fund   improves access to health care services for the poorest by paying healthcare providers on behalf of patients. The tasks of identifying eligible households and payment of financial compensation are entrusted to a purchasing body that is independent from health care providers and supported by an external donor.

In Cambodia, this scheme has been effective in improving financial access to secondary level health services for the poorest. More than 30 experiences are now in operation countrywide. The strategy is also being tested in some Asian and African countries.

Stakeholders in Cambodia have identified several conditions for a successful Health Equity Fund. These include:

• careful design and implementation
• reliable external funding source to cover the health services subsidies
• combination with other interventions aimed at fostering quality of services and providers accountability
• entrustment of provider and purchaser functions to separate actors
• use of a combination of targeting techniques
• inclusion of hospital care and transportation costs in the benefit package in order to alleviate financial barriers.