title: Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia.
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 27 US dollars 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.
authors.affiliation: Institute of Business and Economic Research, University of California, Berkeley, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Barber
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bonnet
authors.forename: Henk
authors.initials: H
authors.lastname: Bekedam
mesh_terms: D002160:Cambodia; D003363:Cost Control; D005382:Financing, Personal; D005102:Health Expenditures; D017721:Hospital Costs; D012051:Reimbursement Mechanisms