Subsidised exemption schemes
Access to health care for all? User fees plus a health equity fund in Sotnikum, Cambodia
Health Equity Fund enables the poor to access hospital services in Cambodia
Authors:
W. Hardeman; W. Van Damme; M. Van Pelt; I. R. Por
Publisher:
Health Policy and Planning, 2004
This paper, published in Health Policy and Planning, presents the experience of a Health Equity Fund managed by a local non-governmental organisation (NGO) in Sotnikum, Cambodia. The aim of the Health Equity Fund was to identify the poor and pay the costs of hospitalisation on their behalf (including indirect costs such as food and transportation). The paper identifies four major constraints to access faced by the poor: financial, geographical, informational and intra-household. Findings show that the Health Equity Fund was effective in helping the poor to overcome many of these constraints, leading to a steep increase in numbers of poor people accessing the hospital. The Fund effectively improved financial access for the poor, reduced expenditure on poor-quality private sector services, and was very cost-effective, with minimal “leakage” to non-poor.
The authors conclude that Health Equity Funds managed by motivated local NGOs can contribute more effectively to poverty reduction than a system of waivers for poor patients. However, they acknowledge that in the longer term, and on a larger scale, problems may arise such as leakage to non-poor who may adapt their self-reported status. Further research and experimentation are recommended in different contexts and with different set-ups. [adapted from authors]
