Out-of-pocket expenditures for health care have significantly increased in Cambodia, placing families hovering just above the poverty line at risk of being plunged back into indigence, according to a recent report from the World Health Organization (WHO).

In the WHO’s recent Tracking Universal Health Coverage report, released on Friday, Cambodia was named as one of 37 countries where 6 per cent of the population could be tipped or pushed further into extreme poverty – living on $1.25 per day or less – due to out-of-pocket health costs.

“The risk of being pushed into poverty by health care expenditure is not low in Cambodia,” said Dr Momoe Takeuchi, WHO Cambodia’s acting health systems team leader.

Such costs accounted for 60 per cent of Cambodia’s total health expenditure in 2014 – some $622 million out of a little more than $1 billion, according to the Ministry of Health’s expenditure analysis published this March.

Due to a lack of access to services, higher health care costs and the low coverage of government-funded health care, patients are forced to pay for medical care themselves, leading the average yearly out-of-pocket cost per person to increase by 57 per cent to a total of $50 between 2010 and 2013.

In 2013, at least 100,000 people in Cambodia struggled with high medical bills, with half falling into debt, and some falling beneath the poverty line as a result, according to the MoH’s Annual Health Financing Report 2015.

The groups that feel most of this financial strain, the WHO’s Takeuchi said, are also the ones that lack access to some essential health services: the poor and near-poor, migrants, the elderly, people with disabilities, ethnic minorities, rural residents, mothers and children with mothers who have a low education.

“They are all vulnerable populations and at a potential risk of not being able to access needed essential services, and [are] not under any social health protection mechanisms,” she said.

One solution to strengthening the Kingdom’s social health protection system, as recognised by most health experts, is initiating universal health coverage.

But that is only achievable if in a step-by-step basis “starting with devising a better financing system”, said Dr Sin Somuny of health sector NGO umbrella group MEDiCAM.

“There is no quick fix. Health financing in the country is too fragmented and we need to consolidate it if we were to ever reach universal health coverage,” Somuny said. “We have some community-based insurance, the Health Equity Fund for those living below the poverty line and some other social programs, but there’s no strategic direction to it.”

A new National Health Financing Policy is currently undergoing inter-ministerial review, according to the WHO report, but Health Ministry officials declined to comment yesterday.

“The Royal Government of Cambodia is discussing a more comprehensive social health protection mechanism to eventually cover all the population, including those in the informal sector, but these systems will take time to establish,” Takeuchi said.