Rural Household Strategies to Cope with Health Shocks យុទ្ធសាស្រ្តរបស់គ្រួសារជនបទក្នុងការ ដោះស្រាយបញ្ហាគ្រោះថ្នាក់សុខភាព Mr. Eut Sokkea (លោក អ៊ឺត សុខគា) Field Supervisor(ប្រធានក្រុមស្រាវជ្រាវ) ដំរីស្រាវជ្រាវ និងផ្តល់ប្រឹក្សា Raffles Hotel Le Royale Oct 5th, 2011

About the study អំពីការសិក្សាស្រាវជ្រាវ Data taken from the SKY impact evaluation follow up survey July 2009 – January 2010 ទិន្នន័យនេះយកចេញពីការស្ទង់មតិតាមដានការវាយតំលៃឥទ្ធិពល​ធានារ៉ាប់រងសុខភាពស្កាយពីខែ កក្កដា 2009-មករា 2010 5275 households interviewed គ្រួសារចំនួន 5275ត្រូវបានគេធ្វើសំភាសន៍ 245 villages in 3 provinces: Takeo, Kandal and Kampot ភូមិចំនួន 245ត្រូវបានគេជ្រើសចេញពីខេត្តចំនួនបីៈ តាកែវ កណ្តាល និងកំពត

Health Shocks បញ្ហាគ្រោះថា្នក់សុខភាព 46% of households reported experiencing at least 1 health shock in the 12 months preceding the survey. គ្រួសារ46%ត្រូវបានគេរាយការណ៍មកថាមានបញ្ហាសុខភាពយ៉ាង​តិចម្តងក្នុងរយៈពេល12ខែមុនធ្វើការវាស់ស្ទង់មតិ 3) For households that reported health shocks, we examined the total cost of all health shocks experienced over one year by combining the cost of all treatments sought (including transportation costs). The median total cost to households of health shocks over one year was $60.

In many cases, households sought multiple treatments for their health shock. នៅក្នុងករណីជាច្រើន គ្រួសារបានស្វែងរកពហុព្យាបាលសំរាប់​បញ្ហាគ្រោះថា្នក់សុខភាពរបស់ពួកគេ The median total cost to households of health shocks over 1 year = $60 តំលៃព្យាបាលសរុបជាមធ្យមចំពោះគ្រួសារដែលជួបគ្រោះថ្នាក់​សុខភាពលើសពី 1ឆ្នាំ = $60

Distribution of total cost of health shocks បំនែងចែកថ្លៃព្យាបាលគ្រោះថ្នាក់សុខភាពសរុប When we examined the distribution of the total cost of health shocks by households, we found that for most households the total cost of health shocks was under $100, indeed for 50% of households, the total cost of all health shocks was less than $60 and for 10% of households the total cost over one year was less than $7. However, it is important to note that even relatively low treatment costs can be financially damaging to households in the absence of regular income or social protection schemes. In 36% of households, the total cost of health shocks was over $100. A quarter of households had total expenditure costs of health shocks of almost $150. 10% of households had total costs of over $370 and for 5% of households the total cost of all health shocks exceeded $600 – almost as much as the GNI per capita in 2009.

How do households pay for their health shocks Households in the sample used a wide range of coping strategies to pay for the costs associated with treatment for their health shocks. When we disaggregated by treatments under and over $100, we found that coping strategies differed according to cost of treatment. Since treatment costs require a lump sum payment, coping strategies involving quick access to cash were the most popular with using ‘cash on hand’ a very popular strategy for both high and low treatment costs. For very high treatment costs, borrowing money was the most popular coping strategy. Households borrowed money to pay for almost 40% of treatments over $100. In comparison, for treatments costing under $100, less than a quarter of households borrowed money. Of all the loans taken out to pay for treatment costs, 64% were borrowed with interest. Furthermore, when we looked at the relationship between debt and health shocks, we found that a higher proportion of households who experienced at least one health shock were in debt compared to those who had not experienced any health shock. Receiving help from family and selling assets were both more frequently used for treatments costing over $100 than for lower treatment costs. For treatment costs over $100, a quarter of households sold an asset. Less than 10 percent of households were able to find extra work to pay for the cost of treatment. SKY health insurance paid for 9% of treatments.

Asset Sales ការលក់ទ្រព្យសម្បត្តិ Asset sales varied significantly depending on the cost of treatment. When treatment costs were under $100, households mostly sold poultry and rice. (As explored in our third policy briefing poultry and rice are important commodity savings in Cambodia and are often sold in times of need). Food (predominantly rice) was sold when treatment costs were both high and low. When expenditure was particularly high, livestock was the most frequently sold asset followed closely by food. The data shows that land sales are extremely rare as a coping strategy, especially when treatment costs were under $100. When treatment costs were over $100, land sales accounted for 13% of all assets sold. When land was sold it was predominantly when treatment costs were very high; the median treatment cost for households who sold land was almost seven times higher than for those who sold all other types of assets. Poorer households were much more likely to sell land as a coping strategy to pay for treatment costs associated with health shocks, however, the sale of land is still extremely rare with just five poor households selling land to pay for treatment out of 2392 households.

Place of Treatment កន្លែងព្យាបាល We found that the place of treatment varied according to the cost of treatment. The majority of treatments costing over $100 were sought in the private sector; 34% of treatments from a private town health provider and 21% from a private village provider. 28% of treatments costing over $100 were sought from a public hospital. In comparison for treatments costing under $100, the main provider was a private village doctor with 28% of treatments sought there. Lastly, more treatments costing under $100 than over $100 were sought in a public health centre – though still only 14%.

Key findings at a glance.. របកគំហើញសំខាន់ៗ Median total cost of health shocks per household $60, but for 36% of households the total cost exceeded $100. ថ្លៃព្យាបាលគ្រោះថ្នាក់សុខភាពសរុបជាមធ្យមក្នុងមួយគ្រួសារ $60 ប៉ុន្តែ​សំរាប់គ្រួសារ36%ទៀត ថ្លៃព្យាបាលសរុបមានលើស $100។ A significant amount in rural Cambodia Borrowing – representing major threat to economies of households.

Treatment costs require lump sum payment and so coping strategies involving quick access to cash most popular. ថ្លៃព្យាបាលទាមទារអោយបង់ជាកញ្ចប់ ដូចនេះយុទ្ធសាស្រ្តដោះស្រាយរបស់ពួកគេ​ជាប់ទាក់ទងញឹកញាប់បំផុតទៅនឹងលទ្ធភាពទូទាត់ជាសាច់ប្រាក់ភ្លាមៗ Borrowing money was one of the most common strategies – particularly when treatment costs very high ការខ្ចីប្រាក់គេជាយុទ្ធសាស្រ្តមួយក្នុងចំនោមយុទ្ធសាស្រ្តដែលគេ​ប្រើញឹកញាប់បំផុត- ជាពិសេសនៅពេលថ្លៃព្យាបាលខ្ពស់ខ្លាំង

Key findings at a glance.. របកគំហើញសំខាន់ៗ Asset sales were rare. For treatments under $100 households = Poultry and rice. For high treatment costs = livestock ការលក់ទ្រព្យកំរកើតមានណាស់។ សំរាប់ការព្យាបាលក្រោម $100 គ្រួសារ = បសុសត្វ និងស្រូវ។ សំរាប់ថ្លៃព្យាបាលខ្ពស់ = សត្វពាហនៈ Asset sales were much less frequent coping strategies to deal with health shocks. For treatments under $100 households sold poultry and rice. For high treatment costs, more likely to sell livestock than land. Land sales extremely rare, even among poorest households. Households only sold land when treatment costs were very high; the median treatment cost for households who sold land was over 12 times as much as for other asset sales.

Land sales extremely rare (4%) Land sales extremely rare (4%). Households only sold land when treatment costs were very high; the median treatment cost for households who sold land was over 12 times as much as for other asset sales. ការលក់ដីធ្លីពិតជាកំរកើតមានខ្លាំងណាស់។ គ្រួសារលក់ដីនៅពេលដែលការព្យាបាលមានតំលៃខ្ពស់ខ្លាំងប៉ុណ្ណោះ។ ថ្លៃព្យាបាល​ជាមធ្យមសំរាប់គ្រួសារដែលលក់ដីមានច្រើនជាង 12ដង បើធៀប​នឹងការលក់ទ្រព្យផ្សេងៗទៀត។