Out‐of‐pocket health expenditure and debt in poor households: evidence from Cambodia

Summary Objectives  To document how out‐of‐pocket health expenditure can lead to debt in a poor rural area in Cambodia. Methods  After a dengue epidemic, 72 households with a dengue patient were interviewed to document health‐seeking behaviour, out‐of‐pocket expenditure, and how they financed such e...

Full description

Saved in:
Bibliographic Details
Published in:Tropical medicine & international health 2004-02, Vol.9 (2), p.273-280
Main Authors: Damme, Wim Van, Leemput, Luc Van, Por, Ir, Hardeman, Wim, Meessen, Bruno
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cambodia
Cambodia - epidemiology
catastrophic health expenditure
dengue
Dengue - economics
Dengue - epidemiology
Disease Outbreaks - economics
Financing, Personal - economics
General aspects
Health Care Surveys - methods
Health Expenditures
health system
Humans
Medical sciences
out‐of‐pocket expenditure
Patient Acceptance of Health Care
poverty
Poverty - economics
Private Practice - economics
private providers
Rural Health
State Medicine - economics
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Objectives  To document how out‐of‐pocket health expenditure can lead to debt in a poor rural area in Cambodia. Methods  After a dengue epidemic, 72 households with a dengue patient were interviewed to document health‐seeking behaviour, out‐of‐pocket expenditure, and how they financed such expenditure. One year later, a follow‐up visit investigated how the 26 households with an initial debt had coped with it. Results  The amount of out‐of‐pocket health expenditure depended mostly on where households sought care. Those who had used exclusively private providers paid on average US$103; those who combined private and public providers paid US$32, and those who used only the public hospital US$8. The households used a combination of savings, selling consumables, selling assets and borrowing money to finance this expenditure. One year later, most families with initial debts had been unable to settle these debts, and continued to pay high interest rates (range between 2.5 and 15% per month). Several households had to sell their land. Conclusions  In Cambodia, even relatively modest out‐of‐pocket health expenditure frequently causes indebtedness and can lead to poverty. A credible and accessible public health system is needed to prevent catastrophic health expenditure, and to allow for other strategies, such as safety nets for the poor, to be fully effective.
ISSN:1360-2276
1365-3156
DOI:10.1046/j.1365-3156.2003.01194.x