Related Experiment Video
Updated: Jun 21, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Barriers to access and the purchasing function of health equity funds: lessons from Cambodia
Maryam Bigdeli1, Peter Leslie Annear
1Department of Health Systems, Cambodian office of the World Health Organization, Phnom Penh, Cambodia. bigdelim@wpro.who.int
Insights
Health equity funds (HEF) in Cambodia improved access to public health services for low-income populations by addressing financial barriers. While HEF increased facility use, some patients still faced borrowing for care, highlighting the need for continued support.
Area of Science:
- Health economics
- Public health policy
- Healthcare access
Background:
- High out-of-pocket payments and user fees impede healthcare access for the poor.
- Health equity funds (HEF) were introduced in Cambodia as a strategic purchasing mechanism to fund exemptions for low-income individuals.
- Examining the impact of HEF on healthcare access is crucial.
Purpose of the Study:
- To define barriers to healthcare access.
- To analyze the role of HEF in addressing these barriers.
- To evaluate the impact of HEF on healthcare utilization.
Main Methods:
- Review of evidence on barriers to healthcare access.
- Analysis of the role and mechanisms of HEF.
- Examination of how HEF address identified barriers.
Main Results:
- HEF increased patient numbers at public facilities, meeting some unmet healthcare needs.
- No stigma was associated with HEF use, but many beneficiaries still borrowed money for care.
- User fees remain a barrier to public services for the very poor, despite HEF.
Conclusions:
- HEF function as a vital purchasing mechanism in Cambodia's health system.
- Key roles of HEF include financing, community support, quality assurance, and policy dialogue.
- Effective HEF implementation requires a supportive policy environment and third-party arrangements for maximum impact.
Problem:
High out-of-pocket payments and user fees with unfunded exemptions limit access to health services for the poor. Health equity funds (HEF) emerged in Cambodia as a strategic purchasing mechanism used to fund exemptions and reduce the burden of health-care costs on people on very low incomes. Their impact on access to health services must be carefully examined.
Approach:
Evidence from the field is examined to define barriers to access, analyse the role played by HEF and identify how HEF address these barriers.
Local Setting:
Two-thirds of total health expenditure consists of patients' out-of-pocket spending at the time of care, mainly for self-medication and private services. While the private sector attracts most out-of-pocket spending, user fees remain a barrier to access to public services for people on very low incomes.
Relevant Changes:
HEF brought new patients to public facilities, satisfying some unmet health-care needs. There was no perceived stigma for HEF patients but many of them still had to borrow money to access health care.
Lessons Learned:
HEF are a purchasing mechanism in the Cambodian health-care system. They exercise four essential roles: financing, community support, quality assurance and policy dialogue. These roles respond to the main barriers to access to health services. The impact is greatest where a third-party arrangement is in place. A strong and supportive policy environment is needed for the HEF to exercise their active purchasing role fully.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:11Secondary Healthcare System
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...