A micro-health insurance scheme which offers impoverished Cambodian households unlimited primary and emergency care for a super low monthly premium plans to expand into most of Cambodia's provinces and pull in a membership of up to 150,000 in the next four years.
The Sokapheap Krousar Yeung (SKY) - health for our families - insurance project was initiated by the French NGO Groupe d'Echange et de Recherche Technologiques (GRET) in Takeo in 1998. It has since continued to expand and is now also operating in Kandal and Kampot provinces and in Phnom Penh. The project is funded by the French Development Agency (FDA), the French Ministry of Foreign Affairs, in partnership with the Cambodian Ministry of Health and Swiss Red Cross, and supported by the GTZ (the German government's technical cooperation agency).
The health insurance premiums are subsidized by GRET so that poor, vulnerable - mainly rural - families can afford them. Depending on the area, the monthly premiums cost between US$0.50 to US$0.98 for a single person and increase according to the number in the family. For an eight-person family the cost is from US$1.83 to US$2.68. The policies run in partnership with local public health facilities, which receive payment for their services from GRET in advance. The benefits aim to be comprehensive with unlimited access to designated hospitals and medical centers, including free prescribed drugs. In addition there is a funeral grant and cash assistance for mothers who attend hospitals to give birth, which aims to promote the mothers' safety.
An evaluation of the project, co-funded by the US Agency for International Development (USAID) and FDA, is being led by Berkeley University, California in cooperation with the Royal University of Phnom Penh. It was launched on Feb 8 and will finish in 2011.
The assessment aims to measure the impact of SKY's health insurance on the financial security and overall health levels of its clients, and also the attitudes of the general population towards public healthcare services, according to an announcement from the French Embassy.
The program currently has around 10,000 members but plans to increase this to 100,000 to 150,000 by 2012.
"Health insurance is an important issue for the majority of Cambodians," said Cedric Salze, a GRET representative. "This project focuses mainly on expenses of the poor for basic health services, and this [will] contribute to poverty reduction," he said, adding that the project will expand into most other provinces later.
Jean David Naudet, an FDA representative, praised the cooperation between various institutions on the project, adding that it could serve as a model for other initiatives.
Deputy Chief of the Ministry of Health's Department of Planning and Health Information Sok Kanha said that the government's budget for health sector support is increasing from year to year, as its equity fund project currently still only covers less than 50 percent of the population.
Sanet Vathana, an official from the Ministry of Social Affairs, Veterans and Youth Rehabilitation, said the government will also implement health insurance schemes for citizens in the future, with the ministry taxing civil servants' salaries.
"In this way government officials and the government will all share the cost," he said. Mey Van, chief of the Department of Industry and Finance, said both citizens and government officials at all levels need a proper healthcare system, but that the state cannot supply all of it due to a limited national budget.
Debts incurred by rising health expenditure are forcing many poor families to sell their land, creating a poverty trap, adds the press release. On average, each Cambodian spends around 18 dollars a year on health services - a large cost in a nation where annual salaries have been estimated by USAID to be as low as US$430.
Khuon Leakhana is a journalist at The Mekong Times