Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia

Type Journal Article - Health Policy and Planning
Title Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia
Author(s)
Volume 19
Issue 4
Publication (Day/Month/Year) 2004
Page numbers 199-208
URL http://heapol.oxfordjournals.org/content/19/4/199.short
Abstract
Growing evidence has demonstrated that informal fees for health services comprise a large proportion of
total health spending in some countries. In 1999, individual out-of-pocket payments for health in Cambodia
were estimated at US$27 per person, with a proportion paid as under-the-table fees at public facilities. By
formalizing such payments and implementing resource management systems within a comprehensive
health financing scheme, Takeo Referral Hospital controlled out-of-pocket patient expenditures, ensured
patients of fixed prices, protected patients from the unpredictability of hospital fees and promoted financial
sustainability. Utilization levels increased by more than 50% for inpatient and surgical services, and cost
recovery from user fees averaged 33%. Furthermore, the hospital phased out external donor support gradually
over 4 years and achieved financial sustainability.

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