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System-wide analysis of health financing equity in Cambodia: a study protocol
  1. Virginia Wiseman1,2,
  2. Augustine Asante1,
  3. Por Ir3,
  4. Supon Limwattananon4,5,
  5. Bart Jacobs6,
  6. Marco Liverani2,
  7. Andrew Hayen7,
  8. Stephen Jan8
  1. 1Department of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  3. 3National Institute of Public Health, Phnom Penh, Cambodia
  4. 4Khon Kaen University, Khon Kaen, Thailand
  5. 5Ministry of Public Health International Health Policy Program (IHPP), Thailand
  6. 6Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
  7. 7Faculty of Health, University of Technology Sydney Sydney, New South Wales, Australia
  8. 8George Institute for Global Health, Sydney, New South Wales, Australia
  1. Correspondence to Dr Virginia Wiseman; Virginia.wiseman{at}lshtm.ac.uk

Abstract

Background To assess progress towards universal health coverage, countries like Cambodia require evidence on equity in the financing and distribution of healthcare benefits. This evidence must be based on a system-wide perspective that recognises the complex roles played by the public and private sectors in many contemporary healthcare systems.

Objective To undertake a system-wide assessment of who pays and who benefits from healthcare in Cambodia and to understand the factors influencing this.

Methods Financing and benefit incidence analysis will be used to calculate the financing burden and distribution of healthcare benefits across socioeconomic groups. Data on healthcare usage, living standards and self-assessed health status will be derived from a cross-sectional household survey designed for this study involving a random sample of 5000 households. This will be supplemented by secondary data from the Cambodian National Health Accounts 2014 and the Cambodian Socioeconomic Survey (CSES) 2014. We will also collect qualitative data through focus group discussions and in-depth interviews to inform the interpretation of the quantitative analyses.

Potential impact This study will produce previously unavailable information on who pays for, and who benefits from, health services across the entire health system of Cambodia. This evidence comes at a critical juncture in healthcare reform in South-East Asia with so many countries seeking guidance on the equity impact of their current financing arrangements that include a complex mix of public and private providers.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2016-000153

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors All authors contributed to the design of the study. AA, AH, SL and PI led the design of the quantitative component of the study. ML, PI and BJ led the design of the qualitative component of the study. VW and SJ led the drafting of the manuscript, which was reviewed and commented on by all authors.

    • Funding Australian Research Council. Grant number (DP150101321).

    • Competing interests None declared.

    • Ethics approval National Ethics Committee for Health Research in Cambodia (REF: 362 NECHR) and the University of New South Wales (REF: HC1543).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.