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. 2023 Jan 12;13(1):e061959.
doi: 10.1136/bmjopen-2022-061959.

Healthcare usage and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Srean Chhim  1   2 , Vannarath Te  3   2   4 , Veerle Buffel  5 , Josefien van Olmen  6 , Savina Chham  3   7 , Sereyraksmey Long  2 , Sokunthea Yem  3 , Wim Van Damme  8   9 , Edwin Wouters  5 , Ir Por  10
Affiliations

Healthcare usage and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

Srean Chhim et al. BMJ Open. .

Abstract

Objective: To assess usage of public and private healthcare, related healthcare expenditure, and associated factors for people with type 2 diabetes (T2D) and/or hypertension (HTN) and for people without those conditions in Cambodia.

Methods: A cross-sectional household survey.

Settings: Five operational districts (ODs) in Cambodia.

Participants: Data were from 2360 participants aged ≥40 years who had used healthcare services at least once in the 3 months preceding the survey.

Primary and secondary outcome: The main variables of interest were the number of healthcare visits and healthcare expenditure in the last 3 months.

Results: The majority of healthcare visits took place in the private sector. Only 22.0% of healthcare visits took place in public healthcare facilities: 21.7% in people with HTN, 37.2% in people with T2D, 34.7% in people with T2D plus HTN and 18.9% in people without the two conditions (p value <0.01). For people with T2D and/or HTN, increased public healthcare use was significantly associated with Health Equity Fund (HEF) membership and living in ODs with community-based care. Furthermore, significant healthcare expenditure reduction was associated with HEF membership and using public healthcare facilities in these populations.

Conclusion: Overall public healthcare usage was relatively low; however, it was higher in people with chronic conditions. HEF membership and community-based care contributed to higher public healthcare usage among people with chronic conditions. Using public healthcare services, regardless of HEF status reduced healthcare expenditure, but the reduction in spending was more noticeable in people with HEF membership. To protect people with T2D and/or HTN from financial risk and move towards the direction of universal health coverage, the public healthcare system should further improve care quality and expand social health protection. Future research should link healthcare use and expenditure across different healthcare models to actual treatment outcomes to denote areas for further investment.

Keywords: General diabetes; HEALTH ECONOMICS; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Hypertension; Organisation of health services.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Data flow from household selection to final dataset in this study, Cambodia, 2020. HT, hypertension; ODs, operational districts; T2D, type 2 diabetes.
Figure 2
Figure 2
Proportion of visits to public and private facilities in Cambodia, 2020. HT, hypertension; T2D, type 2 diabetes.
Figure 3
Figure 3
Healthcare expenditure by patient groups in the 3 months preceding the survey in 2020, Cambodia. HT, hypertension; T2D, type 2 diabetes.
See this image and copyright information in PMC

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References

    1. World Health Organization . Cardiovascular diseases, 2020. Available: http://origin.who.int/cardiovascular_diseases/en/ [Accessed 16 Jan 2022].
    1. World Health Organization . Global report on diabetes, 2016. Available: https://www.who.int/publications/i/item/9789241565257 [Accessed 16 Jan 2022].
    1. World Health Organization . Hypertension, 2019. Available: https://www.who.int/news-room/fact-sheets/detail/hypertension [Accessed 16 Jan 2022].
    1. University of Health Sciences . National noncommunicable disease risk factor survey: STEPS survey. Phnom Penh: University of Health Sciences, 2016.
    1. World Health Organization . The Kingdom of Cambodia health system review, 2015. Available: https://apps.who.int/iris/bitstream/handle/10665/208213/9789290616917_en... [Accessed 16 Jan 2022].

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