IDEAS home Printed from https://ideas.repec.org/p/hal/wpaper/hal-03437399.html
   My bibliography  Save this paper

Hardship Financing, Productivity Loss, and the Economic Cost of Illness and Injury in Cambodia

Author

Listed:
  • Robert John Kolesar

    (Abt Associates, UA - University of Antwerp, Cambodian Ministry of Economy and Finance, CERDI - Centre d'Études et de Recherches sur le Développement International - IRD - Institut de Recherche pour le Développement - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne)

  • Guido Erreygers

    (UA - University of Antwerp)

  • Wim van Dam

    (ITM - Institute of Tropical Medicine [Antwerp])

  • Vanara Chea

    (Cambodian Ministry of Economy and Finance)

  • Theany Choeurng

    (Cambodian Ministry of Economy and Finance)

  • Soklong Leng

    (Cambodian Ministry of Economy and Finance)

Abstract

Financial risk protection is a core dimension of Universal Health Coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. To inform efforts to improve Cambodia's social health protection system we analyze 2019-2020 Cambodia Socioeconomic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. More than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are having an Equity card, higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to USD 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is USD 250.8 million or 0.9% of GDP. Such losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders.

Suggested Citation

  • Robert John Kolesar & Guido Erreygers & Wim van Dam & Vanara Chea & Theany Choeurng & Soklong Leng, 2021. "Hardship Financing, Productivity Loss, and the Economic Cost of Illness and Injury in Cambodia," Working Papers hal-03437399, HAL.
  • Handle: RePEc:hal:wpaper:hal-03437399
    Note: View the original document on HAL open archive server: https://uca.hal.science/hal-03437399
    as

    Download full text from publisher

    File URL: https://uca.hal.science/hal-03437399/document
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Narayan, Seema & Narayan, Paresh Kumar & Mishra, Sagarika, 2010. "Investigating the relationship between health and economic growth: Empirical evidence from a panel of 5 Asian countries," Journal of Asian Economics, Elsevier, vol. 21(4), pages 404-411, August.
    2. Clarke, Philip & Erreygers, Guido, 2020. "Defining and measuring health poverty," Social Science & Medicine, Elsevier, vol. 244(C).
    3. Islam, Asadul & Maitra, Pushkar, 2012. "Health shocks and consumption smoothing in rural households: Does microcredit have a role to play?," Journal of Development Economics, Elsevier, vol. 97(2), pages 232-243.
    4. Stephen B. DeLoach & Marquessa Smith-Lin, 2018. "The Role of Savings and Credit in Coping with Idiosyncratic Household Shocks," Journal of Development Studies, Taylor & Francis Journals, vol. 54(9), pages 1513-1533, September.
    5. Kolesar, Robert John & Pheakdey, Sambo & Jacobs, Bart & Phay, Sokchegn, 2021. "Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia," Journal of Policy Modeling, Elsevier, vol. 43(1), pages 127-145.
    6. Paul Gertler & David I. Levine & Enrico Moretti, 2009. "Do microfinance programs help families insure consumption against illness?," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 257-273, March.
    7. World Bank Group, 2017. "Cambodia Economic Update, April 2017," World Bank Publications - Reports 27540, The World Bank Group.
    8. Arora, Suchit, 2001. "Health, Human Productivity, And Long-Term Economic Growth," The Journal of Economic History, Cambridge University Press, vol. 61(3), pages 699-749, September.
    9. Manoj Mohanan, 2013. "Causal Effects of Health Shocks on Consumption and Debt: Quasi-Experimental Evidence from Bus Accident Injuries," The Review of Economics and Statistics, MIT Press, vol. 95(2), pages 673-681, May.
    10. Schicks, Jessica, 2014. "Over-Indebtedness in Microfinance – An Empirical Analysis of Related Factors on the Borrower Level," World Development, Elsevier, vol. 54(C), pages 301-324.
    11. World Bank Group, 2017. "Cambodia Economic Update, October 2017," World Bank Publications - Reports 28929, The World Bank Group.
    12. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    13. Pavel, Md Sadik & Chakrabarty, Sayan & Gow, Jeff, 2015. "Cost of illness for outpatients attending public and private hospitals in Bangladesh," MPRA Paper 74491, University Library of Munich, Germany, revised 03 Sep 2016.
    14. Flores, Gabriela & Ir, Por & Men, Chean R. & O’Donnell, Owen & van Doorslaer, Eddy, 2013. "Financial protection of patients through compensation of providers: The impact of Health Equity Funds in Cambodia," Journal of Health Economics, Elsevier, vol. 32(6), pages 1180-1193.
    15. Adam Wagstaff & Magnus Lindelow, 2014. "Are Health Shocks Different? Evidence From A Multishock Survey In Laos," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 706-718, June.
    16. Robert Kolesar & Sambo Pheakdey & Bart Jacobs & Narith Chan & Samedy Yok & Martine Audibert, 2020. "Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations," Post-Print hal-02545747, HAL.
    17. David N. Well, 2007. "Accounting for the Effect Of Health on Economic Growth," The Quarterly Journal of Economics, Oxford University Press, vol. 122(3), pages 1265-1306.
    18. Gathergood, John, 2012. "Self-control, financial literacy and consumer over-indebtedness," Journal of Economic Psychology, Elsevier, vol. 33(3), pages 590-602.
    19. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    20. Robert J. Kolesar & Sambo Pheakdey & Bart Jacobs & Narith Chan & Samedy Yok & Martine Audibert, 2020. "Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations," International Social Security Review, John Wiley & Sons, vol. 73(1), pages 35-63, January.
    21. Sophie Mitra & Michael Palmer & Daniel Mont & Nora Groce, 2016. "Can Households Cope with Health Shocks in Vietnam?," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 888-907, July.
    22. Robert Kolesar & Sambo Pheakdey & Bart Jacobs & Narith Chan & Samedy Yok & Martine Audibert, 2020. "Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations," Post-Print hal-02545471, HAL.
    23. Clayton, Maya & Liñares-Zegarra, José & Wilson, John O.S., 2015. "Does debt affect health? Cross country evidence on the debt-health nexus," Social Science & Medicine, Elsevier, vol. 130(C), pages 51-58.
    24. Husain, Muhammad Jami, 2009. "Contribution of health to economic development: a survey and overview," Economics Discussion Papers 2009-40, Kiel Institute for the World Economy (IfW Kiel).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Robert John Kolesar & Peter Bogetoft & Vanara Chea & Guido Erreygers & Sambo Pheakdey, 2022. "Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia," Health Economics Review, Springer, vol. 12(1), pages 1-20, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Robert John Kolesar & Peter Bogetoft & Vanara Chea & Guido Erreygers & Sambo Pheakdey, 2022. "Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia," Health Economics Review, Springer, vol. 12(1), pages 1-20, December.
    2. Tianxin Pan & Michael Palmer & Ajay Mahal & Peter Annear & Barbara McPake, 2020. "The long‐run effects of noncommunicable disease shocks," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1549-1565, December.
    3. Abhishek Dureja & Digvijay S. Negi, 2022. "Coping with the consequences of short‐term illness shocks: The role of intra‐household labor substitution," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1402-1422, July.
    4. Neelsen, Sven & Limwattananon, Supon & O'Donnell, Owen & van Doorslaer, Eddy, 2019. "Universal health coverage: A (social insurance) job half done?," World Development, Elsevier, vol. 113(C), pages 246-258.
    5. Owen (O.A.) O'Donnell, 2019. "Financial Protection Against Medical Expense," Tinbergen Institute Discussion Papers 19-010/V, Tinbergen Institute.
    6. Samaratunge, Ramanie & Kumara, Ajantha Sisira & Abeysekera, Lakmal, 2020. "Breaking the Perverse Health-debt Cycle in Sri Lanka: Policy Options," Journal of Policy Modeling, Elsevier, vol. 42(3), pages 728-745.
    7. Chhay, Panharoth & Rahut, Dil, 2022. "Health Shocks and Overindebtedness: A Panel Data Analysis from Rural Viet Nam," ADBI Working Papers 1311, Asian Development Bank Institute.
    8. Arjun S. Bedi & Sparrow, R.A., 2014. "Sickness and death," ISS Working Papers - General Series 51366, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    9. Khan, Farid & Bedi, Arjun S. & Sparrow, Robert, 2015. "Sickness and Death: Economic Consequences and Coping Strategies of the Urban Poor in Bangladesh," World Development, Elsevier, vol. 72(C), pages 255-266.
    10. Islam, Asadul & Nguyen, Chau & Smyth, Russell, 2015. "Does microfinance change informal lending in village economies? Evidence from Bangladesh," Journal of Banking & Finance, Elsevier, vol. 50(C), pages 141-156.
    11. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    12. Kaiser, Andrea Hannah & Okorafor, Okore & Ekman, Björn & Chhim, Srean & Yem, Sokunthea & Sundewall, Jesper, 2023. "Assessing progress towards universal health coverage in Cambodia: Evidence using survey data from 2009 to 2019," Social Science & Medicine, Elsevier, vol. 321(C).
    13. sowmya, 2015. "Health Shocks and Short-Term Consumption GrowthAuthor-Name: Sowmya Dhanaraj," Working Papers 2015-112, Madras School of Economics,Chennai,India.
    14. Kolesar, Robert John & Pheakdey, Sambo & Jacobs, Bart & Phay, Sokchegn, 2021. "Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia," Journal of Policy Modeling, Elsevier, vol. 43(1), pages 127-145.
    15. Ambrosius, Christian & Cuecuecha, Alfredo, 2013. "Are Remittances a Substitute for Credit? Carrying the Financial Burden of Health Shocks in National and Transnational Households," World Development, Elsevier, vol. 46(C), pages 143-152.
    16. Kalyan Kolukuluri, 2023. "Adverse health shocks, social insurance and household consumption: evidence from Indonesia’s Askeskin program," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 213-235, June.
    17. Pheeha Morudu & Umakrishnan Kollamparambil, 2020. "Health shocks, medical insurance and household vulnerability: Evidence from South Africa," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-17, February.
    18. Garcia-Mandicó, Sílvia & Reichert, Arndt & Strupat, Christoph, 2021. "The Social Value of Health Insurance: Results from Ghana," Journal of Public Economics, Elsevier, vol. 194(C).
    19. Zelalem Yilma & Anagaw Mebratie & Robert Sparrow & Degnet Abebaw & Marleen Dekker & Getnet Alemu & Arjun S. Bedi, 2014. "Coping with shocks in rural Ethiopia," Journal of Development Studies, Taylor & Francis Journals, vol. 50(7), pages 1009-1024, July.
    20. Wonhyung Lee & Nurul Widyaningrum, 2019. "Multidimensional access to financial services: Insights from Indonesia," Progress in Development Studies, , vol. 19(1), pages 21-35, January.

    More about this item

    Keywords

    social health protection; poverty; financial risk protection; Universal Health Coverage; hardship financing;
    All these keywords.

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:wpaper:hal-03437399. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.