Expanding Social Health Protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations

The Government of Cambodia recently launched its National Social Protection Policy Framework to strengthen and expand its social protection system. To inform the future direction of social health protection policy in Cambodia we examine the 2016 Cambodia Socio-economic survey to assess the current coverage potential of existing health insurance schemes and coverage gaps; and, compare fair and equitable contribution rates. The current health coverage expansion efforts are likely to primarily benefit individuals from higher income households. In addition, recent directives to expand coverage to some informal workers leaves significant gaps, particularly among vulnerable groups, farmers, and the self-employed. The average out-of-pocket health care costs exceed capacity to pay among individuals in the lower wealth quintiles. Thus, we conclude they should be considered financially vulnerable. Finally, we illustrate that a fair and equitable approach to individual, monthly healthcare contributions will yield low premium rates and collection costs could exceed the amount collected, particularly among the informal sector. Therefore, we recommend that, in addition to other vulnerable groups and uncovered households in the first wealth quintile, people second and third quintiles who are not formally employed, should be exempted from premium payments as social health protection is expanded.