Evidence base on the impact of ill-health on individuals and households
The impact of the introduction of user fees at a district hospital in Cambodia
Hospital user fees worsened both health and poverty in Cambodia
Authors:
B. Jacobs; J. Price
Publisher:
Health Policy and Planning, 2004
This paper, published in Health Policy and Planning, describes the introduction of user fees at a district referral hospital in Kirivong Operational District in Cambodia, It examines the impact on health care seeking behaviour, the ability to pay and consultation prices at private practitioners. It reports that consultation fees charged by private providers increased in tandem with price increases introduced at the referral hospital. The paper argues that the introduction and subsequent increase in user fees created a “medical poverty trap”, with significant impacts on both health and livelihoods. These impacts included untreated illness, reduced access to care, long-term impoverishment, and irrational use of drugs leading to drug resistance.
The paper recommends that two interventions should be implemented immediately to address the medical poverty trap: regulation of the private sector, and reimbursing health facilities for services provided to patients who are exempted from paying user fees because they are poor. In the longer term, the paper advocates changing from direct payments at the point of service delivery to a social health insurance system in which healthy, high-income groups subsidise health care for low-income groups. For such a system to include the poorest, it may be necessary to subsidise membership fees.
This document is not freely available online. Photocopies can be obtained from the British Library of Development Studies. There is a charge for this service.
