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Financial Protection of Patients through Compensation of Providers: The Impact of Health Equity Funds in Cambodia

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Author Info

  • Gabriela Flores

    (Institute of Health Economics and Management, University of Lausanne, Switzerland, and Institute of Health Policy and Management, Erasmus University Rotterdam)

  • Por Ir

    (Institute of Tropical Medicine, Antwerp, Belgium, Siem Reap Provincial Health Dept., Ministry of Health, Cambodia)

  • Chean R. Men

    (Centre for Advanced Studies, Phnom Penh, Cambodia)

  • Owen O'Donnell

    (Erasmus University Rotterdam, the Netherlands, University of Macedonia, Greece)

  • Eddy van Doorslaer

    (Institute of Health Policy & Management, Erasmus University Rotterdam)

Abstract

Public providers have no financial incentive to respect their legal obligation to exempt the poor from user fees. Health Equity Funds (HEFs) aim to make exemptions effective by giving NGOs responsibility for assessing eligibility and compensating providers for lost revenue. We use the geographic spread of HEFs in Cambodia to identify their impact on out-of-pocket (OOP) payments. Among households with some OOP payment, HEFs reduce the amount by 29%, on average. The effect is larger for households that are poorer, mainly use public health care and live closer to a district hospital. HEFs are more effective in reducing OOP payments when they are operated by a NGO, rather than the government, and when they operate in conjunction with the contracting of public health services. HEFs reduce households' health-related debt by around 25%, on average. There is no significant impact on non-medical consumption and health care utilisation.

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Bibliographic Info

Paper provided by Tinbergen Institute in its series Tinbergen Institute Discussion Papers with number 11-169/3.

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Date of creation: 28 Nov 2011
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Handle: RePEc:dgr:uvatin:20110169

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Web page: http://www.tinbergen.nl

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Keywords: Health Financing; User Fees; Financial Protection; Health Care; Cambodia;

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  1. Ir, Por & Bigdeli, Maryam & Meessen, Bruno & Van Damme, Wim, 2010. "Translating knowledge into policy and action to promote health equity: The Health Equity Fund policy process in Cambodia 2000-2008," Health Policy, Elsevier, vol. 96(3), pages 200-209, August.
  2. World Bank, 2011. "World Development Indicators 2011," World Bank Publications, The World Bank, number 2315, October.
  3. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June.
  4. Puhani P-A., 2010. "The Treatment Effect, the Cross Difference, and the Interaction Term in Nonlinear “Difference-in-Differences” Models," Working Papers ERMES 1004, ERMES, University Paris 2.
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  6. Greene, William, 2010. "Testing hypotheses about interaction terms in nonlinear models," Economics Letters, Elsevier, vol. 107(2), pages 291-296, May.
  7. William Greene, 2004. "The behaviour of the maximum likelihood estimator of limited dependent variable models in the presence of fixed effects," Econometrics Journal, Royal Economic Society, vol. 7(1), pages 98-119, 06.
  8. Akashi, Hidechika & Yamada, Takako & Huot, Eng & Kanal, Koum & Sugimoto, Takao, 2004. "User fees at a public hospital in Cambodia: effects on hospital performance and provider attitudes," Social Science & Medicine, Elsevier, vol. 58(3), pages 553-564, February.
  9. Lucy Gilson & Steven Russell & Kent Buse, 1995. "The political economy of user fees with targeting: Developing equitable health financing policy," Journal of International Development, John Wiley & Sons, Ltd., vol. 7(3), pages 369-401, 05.
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  11. John Mullahy, 1998. "Much Ado About Two: Reconsidering Retransformation and the Two-Part Model in Health Economics," NBER Technical Working Papers 0228, National Bureau of Economic Research, Inc.
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Cited by:
  1. Wagstaff, Adam & Eozenou, Patrick Hoang-Vu, 2014. "CATA meets IMPOV: a unified approach to measuring financial protection in health," Policy Research Working Paper Series 6861, The World Bank.

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