Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses.
BACKGROUND
Older people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians' financial access to health care over time, using nationally representative data to enable the formulation of appropriate responses.


METHODS
Using data from three nationally representative household surveys from 2004, 2009 and 2014, we assess key indicators of financial access to health care for households with older people (aged 60 years or older), and compare these with households without older members. For 2014 data, the determinants of catastrophic health expenses at the 10 and 40 % threshold were determined for older people. Data was stratified by age and place of residence (urban/rural), and analysed using Stata statistical software. Sample weights were calibrated to reflect accurate population composition at the time of the survey. Monetary values for 2004 and 2009 were transformed into 2014 values using annual inflation rate figures.


RESULTS
Care-seeking when sick among older people increased considerably from 2004 to 2014, irrespective of gender or place of residence. There were positive trends in the incidence of catastrophic and impoverishing healthcare expenses over the studied time periods. This was also the case for indebtedness. Rural households with older people were considerable more likely to suffer financial hardship due to health-related expenses than their urban equivalents. In 2014, older people spent 50 % more per month on health care than younger people. Determinants of catastrophic health expenditures among households with older people were residing in a rural area, and having a household member with an illness, especially a non-communicable disease.


CONCLUSIONS
In order to make health care more equitable for older people, efforts should be directed to rural areas. Interventions should include improving management of non-communicable diseases at the primary care level, together with a reconfiguration of social health protection schemes to increase the inclusion of older people.
Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238, Phnom Penh, Cambodia. bart.jacobs@giz.de.
Bart
http://orcid.org/0000-0003-0075-6732
B
Jacobs
Independent consultant, Florence, Italy.
Richard
R
de Groot
Independent consultant, Luxembourgville, Luxembourg, UK.
Adélio
A
Fernandes Antunes
D000368:Aged; D000369:Aged, 80 and over; D002160:Cambodia; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D005260:Female; D005102:Health Expenditures / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
Cambodia; Catastrophic health expenses; Impoverishment; Indebtedness; Low-income country; Non-communicable diseases; Older people; Out-of-pocket expenses; Rural; Social assistance