Roadmap
to
Universal Coverage in CAMBODIA
4th TMR Health Policy & Financing, NOSSAL
11th October 2011
Ros ChhunEang
Bureau of Health Economics and
Financing, DPHI, MoH
Outline
1- Cambodia at a glance
2- Roadmap to UC
3- Progress
4- Challenges
1-Cambodia at a glance
3

Population >14 million; >80% are rural farmers

27 % living under poverty line & almost 90% in rural area

GDP per capita
= US$853

OOP
= 2/3
Existing HF mechanisms







National budget
Global free initiatives....
User fee (not cost recovery, not properly cost),
with exemption policy
Special Operating Agency (SOA+SDG)
Fragmented HEF schemes by NGOs
Voucher by NGOs
CBHI by NGOs
4- Roadmap to UC
No Social health Insurance but there are
Fragmented Social Health Protection schemes
SHP MP development (draft)
Vision: To provide effective and equitable access to
affordable quality of health services for all
Cambodians....?
Pluralistic approaches
Compulsory Social Health Insurance
1.
•
•
Voluntary Insurance
2.
•
3.
SHI for formal private sector under NSSF
SHI for Civil servants under NSSF-C
Community-based health insurance
(CBHI)
Social Assistance (HEF)
Progress

NSSF:
–
–
–

established
has implemented work injury for 2ys
Legal framework for SHI being developed
NSSF:
–
–
established,
Legal framework for SHI being developed

HEF: covers >80% of the poor
- Piloting linkage HEF and CBHI
- Preparing expansion plan
- Studying on HEF institutional arrangement by NOSSAL

CBHI: covers <1% (temporary circular by MEF)

Plan to review health financing charter (user fee, benefit, payment
mechanism)
Plan to review Mater Plan of Social Health Protection

5- Challenges
–
–
–
–
–
–
–
8
Widespread poverty; civil servants and employees are low
paid => Low ability-to-pay.
The majority of the population (>80%) are selfemployed/farmers
Limited understanding of the rationale of pre-payment
schemes among the population => Low commitment &
participation.
The health system constraints : quality of care
Local technical capacity for SHI development is limited
SHP/HEF institutional arrangement
Financial sustainability