ACCIDENT, ILLNESS, OR INJURY 3
3.5 C OST FOR H EALTH C ARE
3.5.1 Distribution of Cost for Health Care
For each ill or injured person, the respondent was asked to state the costs expended for transportation and treatment for each visit to a health care provider. These costs were reported only for living people who had been recently ill or injured and did not include costs incurred for people who had died in the 30 days preceding the interview. Costs are presented in US dollars in Table 3.6. In the case of all treatments, 9 percent of household members spent $1 or less for transportation and treatment for illness or injury, and 21 percent spent $1 to $4. Ten percent of all household members spent $50-$99 for transportation and treatment for illness or injury, and another 10 percent spent $100 or more.
These expenditures varied by type of spending. For transport, 48 percent of household members spent less than $1, 35 percent spent $1 to $4, 8 percent spent $5 to $9, and the rest spent $10 or more. For health care, 6 in 10 household members spent up to $19, 18 percent spent between $20 and $49, 10 percent spent between $50 and $99, and 9 percent spent $100 or more. There were small variations in spending according to order of treatment.
Table 3.6 Distribution of cost for health care
Percent distribution of de jure household members who were ill or injured in the past 30 days and sought treatment by amount of money spent for transport and health care, according to number of treatments, Cambodia 2014
Treatment for illness or injury Amount spent for
transport and health care
First treatment Second treatment Third treatment All treatments Transport Health
care Total Transport Health
care Total Transport Health
care Total Transport Health
care Total
$0-1 50.4 17.3 10.6 46.0 16.4 9.7 51.6 19.2 11.7 48.4 14.9 9.3
$1-4 35.1 20.9 23.7 37.5 22.1 23.9 32.5 26.5 28.7 34.5 19.1 21.1
$5-9 7.5 13.9 15.1 8.4 14.8 15.4 7.6 15.1 16.0 8.1 13.1 13.9
$10-19 4.1 15.8 16.5 4.1 17.7 18.8 3.5 16.5 17.7 4.6 16.0 16.3
$20-49 1.2 15.9 16.6 2.3 15.8 17.7 1.5 13.5 14.8 2.3 17.5 18.5
$50-99 0.4 7.9 8.3 0.5 7.0 7.6 1.1 2.9 3.9 0.7 9.6 10.0
$100+ 0.4 7.7 7.9 0.6 5.6 6.0 1.2 5.1 5.7 0.6 9.2 9.6 Don’t know/
missing 0.8 0.6 1.2 0.6 0.4 0.9 1.0 1.1 1.5 0.8 0.7 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 9,186 9,186 9,186 2,143 2,143 2,143 684 684 684 9,186 9,186 9,186
3.5.2 Expenditures for Health Care
Table 3.7 presents the mean cost of transport and treatment by order of treatment and background characteristics. Mean total costs for first, second, and third treatments are $41.08, $34.27, and $32.19, respectively. Mean cost of transport increases with treatment order, from $2.78 for the first treatment to
$3.59 for the second treatment and then $4.94 for the third treatment.
The mean cost of transport and health care varies according to type of health sector, severity of illness or injury, age group, sex, residence, and province. Examining total costs by type of health sector shows that the highest mean expenditure is for “outside of country/other” treatment, which may include going to Singapore, Thailand, or Vietnam or seeking specialized services. This is true for both costs of transport and costs of health care.
Total cost has continued to increase in the past four years, from a mean of $32.37 in 2010 to
$39.36 in 2014. Increases have been observed in both the public and private sectors, in the first and third treatment cycles, and in transport as well as health care costs. Total “outside of country/other” costs have declined from the level reported in the 2010 CDHS, from $324.26 to $234.93. “Outside of country/other”
treatment is the most expensive treatment option due to high transport ($33.86) and health care ($201.08) costs.
Table 3.7 Expenditures for health care
Mean expenditures in United States dollars for transport and health care by de jure household members who were ill or injured in the past 30 days and sought treatment by order of treatments, according to background characteristics, Cambodia 2014
Treatment for illness or injury
First treatment Second treatment Third treatment All treatments Background
characteristic Transport Health
care Total Transport Health
care Total Transport Health
care Total Transport Health care Total
other 28.48 202.49 230.97 43.27 155.88 199.15 83.19 293.65 376.83 33.86 201.08 234.93 Severity of illness or
injury
Slight 1.22 11.82 13.04 1.23 8.78 10.00 2.51 17.62 20.12 1.28 11.61 12.89 Moderate 2.59 36.97 39.56 2.84 27.13 29.97 2.57 26.32 28.89 2.63 34.50 37.14 Serious 10.22 156.53 166.75 11.16 90.23 101.39 16.27 47.91 64.18 10.96 131.12 142.08 Age
Banteay Meanchey 3.63 53.97 57.59 5.14 48.72 53.86 11.01 46.96 57.97 4.15 52.93 57.08 Kampong Cham 2.71 34.11 36.82 5.70 44.42 50.12 13.98 54.87 68.85 3.71 36.67 40.38 Phnom Penh 2.65 33.59 36.24 1.23 13.21 14.44 2.22 18.24 20.46 2.25 26.82 29.06 Prey Veng 3.54 66.03 69.57 3.10 24.54 27.64 2.53 27.14 29.68 3.32 51.15 54.47 Pursat 3.64 71.72 75.36 5.84 63.55 69.40 na na na 3.90 70.75 74.65 Siem Reap 3.45 37.77 41.21 6.29 40.46 46.75 10.91 43.36 54.27 4.34 38.55 42.89 Svay Rieng 2.32 42.75 45.07 3.10 61.09 64.19 1.44 19.03 20.47 2.42 45.04 47.47 Takeo 3.97 45.15 49.12 3.16 27.19 30.35 3.09 17.77 20.86 3.73 39.24 42.98 Otdar Meanchey 9.70 36.80 46.50 31.14 51.97 83.11 178.65 178.75 357.40 14.74 40.58 55.33 Battambang/Pailin 2.97 37.06 40.03 8.49 51.72 60.21 5.74 33.05 38.79 3.82 38.99 42.82 Kampot/Kep 1.63 34.82 36.45 1.22 13.26 14.48 0.95 8.17 9.13 1.55 30.99 32.54 na = No third treatment was reported
In general, health care costs increased significantly by severity of illness or injury. The total mean cost of health care increased from $11.61 for slight illness or injury to $131.12 for serious conditions. This followed the same pattern established in the 2010 CDHS.
Overall, average health care costs rise consistently with the patient’s age, from $10.74 for children age 0-9 to $62.73 for people age 60 or older. Health care expenditures by sex show that men and women spent about the same on health care ($36.89 and $35.90, respectively). A comparison with the findings of the 2010 CDHS shows that health care spending seems to have become more equitable. In 2010, men spent more than women on health care ($34.28 versus $26.90).
Total health care costs have remained higher in urban areas than in rural areas since the 2010 CDHS. However, the urban-rural difference in health care costs has narrowed considerably due to a decline in costs in urban areas. In urban areas average health care costs decreased from $74.79 in 2010 to
38 • Utilization of Health Services for Accident, Illness, or Injury
$41.76 in 2014, and in rural areas costs increased from $23.55 to $34.95 over the same period. The average transport cost per treatment has not changed much over the past four years (from $2.38 to $3.05). The difference in transport costs in urban and rural areas is small ($3.30 versus $2.98).
Health care expenditures vary greatly in Cambodia’s provinces. The cost of health care is highest in Pursat ($70.75) and lowest in Preah Vihear/Stung Treng ($22.92).
3.5.3 Sources of Money for Health Care Expenditures
Because the health care system in Cambodia is largely fee-based, it is important to know the source of the money used to pay for health care. One goal of the health care system is to have appropriate funding mechanisms for the population to acquire health care without deepening poverty. Table 3.8 shows the different sources of money spent by people seeking treatment for health care. Percentages could sum to greater than 100 because a person could use money from more than one source.
Table 3.8 shows the different sources of money spent by persons who sought treatment for health care. The total percent could be greater than 100 because a person could use money from more than one source. Similar to 2010, the two major sources of money spent on health care are wages or income and savings; in 2014, 64 percent of people who sought health care used money from wages/income and 31 percent used savings. Gifts from relatives or friends and sale of assets were mentioned as a source of funding by 14 percent and 8 percent of those who obtained health care, respectively. Twelve percent of those who had health care treatment said they used money from tontine,1 and 4 percent used money from a health equity fund. Each of the other sources of funding was mentioned by 1 percent or less of respondents.
There are small differences in the source of money spent on health care by type of health sector. In all sectors, the most common source of funding is wages or income (50 percent to 72 percent), followed by savings (22 percent to 33 percent). Gifts from relatives are the next most common source of funding for health care (13 percent to 17 percent).
As severity of illness or injury increases, dependence on loans, sale of assets, gifts, and savings increases; however, spending of wages or income declines as severity of illness or injury increases.
Wages/income was the most common source of funding regardless of the total cost of treatments;
however, as treatment costs increase, the proportion of people who use funds from loans, sale of assets, gifts from relatives, and savings also increases. Health equity funds were used by 15 percent of those spending $0 to $1.
There were no substantial differences in the source of money used for health care costs by the patient’s sex. Urban residents were more likely than rural residents to use wages (86 percent versus 59 percent) but less likely to use savings (13 percent versus 35 percent) for health care.
Large differences were found in the sources of money for health care costs by province. Patients in Phnom Penh, Preah Vihear/Stung Treng, and Kandal were most likely to use wages to pay for their health care (92 percent, 89 percent, and 87 percent, respectively) and among the least likely to use their savings (5 percent and 15 percent, respectively).
Conversely, Kampong Chhnang and Kampot/Kep are the provinces in which health care users are most likely to use savings for health care spending (86 percent and 76 percent, respectively). Patients in Prey Veng are least likely to use wages for health care spending (9 percent). Patients in Svay Rieng (34 percent) had the highest reliance on sale of assets for health care spending. Patients in Otdar Meanchey were most likely to use a health equity fund to finance their health care spending. Approximately 1 of 3 patients (32 percent) in Prey Veng reported gifts from relatives or friends as a source of funding for health care costs.
1 Tontine is an informal group saving and loan scheme in Cambodia.
Table 3.8 Source of money (United States dollars) spent by persons who sought treatment for health care
Among de jure household members who were ill or injured in the 30 days before the survey and who sought treatment, percentage who reported specific sources of expenditures for transport and health care, according to background characteristics, Cambodia 2014
Source of money for health care
Background
1 Total includes 127 non-monetary cases (1 in-kind case and 126 cases of don’t know or missing amount of spending)
2 Includes 7 cases for which information on severity of illness is missing
DISABILITY 4
Key Findings
• Overall, 10 percent of household members age 5 and older suffer with at least one form of disability.
• Twenty-one percent of household members who were ill or injured in the 30 days prior to the interview are disabled.
• The most common types of disabilities reported in the survey are difficulties in seeing, walking or climbing stairs, and concentrating.
• One in 10 men who are not currently employed are disabled, as compared with only 5 percent among other men.
ersons with disabilities are considered vulnerable in Cambodia. The commitment of the Royal Government of Cambodia (RGC) to improving the lives of people with disabilities through recognition of their rights was demonstrated through ratification of the Convention on the Rights of Persons with Disabilities (CRPD) in 2012. The RGC has also enacted a number of disability laws and strategic plans in recent years. The government has developed a National Disability Policy to promote effective service delivery to persons with disabilities, and recently the Disability Rights Initiative Cambodia (DRIC) was jointly developed by the Australian government, the United Nations Development Program (UNDP), the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF). The main objective of this latter initiative is to improve the quality of life of persons with disabilities in Cambodia.
People with disabilities are disadvantaged in workplaces and in other public places. Understanding the prevalence of disabilities in the population and the associated circumstances can improve efforts to remove disabling barriers and provide services that allow people with disabilities to integrate better into society. In the 2014 CDHS, information was collected on each household member age 5 and older about whether he or she had difficulties with seeing, hearing, walking or climbing stairs, remembering or concentrating, performing self-care, or communicating. The survey also collected information as to the severity of these disabilities, that is, whether a disabled person has some difficulty performing the listed activities, a great deal of difficulty, or cannot perform the listed activities at all.