Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Cambodia aims to expand social health protection to move toward Universal Health Coverage. We developed a modeling tool to facilitate the simple, interactive estimation of cost and coverage for three policy alternatives, enabling decision-makers to simultaneously adjust for scenario options currently under consideration. Assuming the adoption of all scenario options, the projected cost of expanding social health protection to all is US$42 million, to vulnerable individuals is US$32.1 million, and to uncovered 1st–3rd wealth quintile people is US$30.4 million. These policy alternatives are projected to increase population coverage to 100%, 89.1%, and 92.5% by 2025, respectively. The results have multiple policy implications. First, given the similar costs and coverage estimates for the targeted approaches, and other considerations, expansion to the 1st–3rd wealth quintiles is recommended. Second, the model quantifies the potential impacts for policy changes relating to each scenario option. The inclusion of dependents under the contributory schemes significantly shifts costs; reversing the policy of non-payment for priority public health services increases public health facility revenue; and, alignment of reimbursement rates leverages demand-side financing which can increase value for money. Finally, the cost estimates provide a basis for economic planning. Revenue raising options include increasing the contribution ceiling for the private employees’ scheme and the progressive adoption of strategic purchasing.