Center for Health Market Innovations (CHMI)

Programs

Community-Based Healh Insurance

last updated Nov 4, 2011

Overview

Implementing organization: 
Cambodian Association for Assistance to Families and Widows
Implementation Partner(s): 
Referral Hospital and Health Center
Legal Status: 
Private (not-for-profit)
Year Launched: 
2003
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Out-of-pocket payments
Additional Source(s) of Funding: 
Donor
Funders: 
Malteser International

Scale

Personnel Employed: 
50-99
Number of Facilities Operated/Networked: 
2
Upscaling: 
CBHI was started with around 2364 insured members (5% of total population under scheme catchment) in 2005, and then by the year of 2006, 2007, 2008, 2009 and 2010 the number has grown to 15000 (19%), 25000 (23%), 35000 (31%), 45000 (39%) and 50000 (43%) respectively.
Summary: 

Community-Based Health Insurance in Thmor Pork is a voluntary community-based and not-for-profit health insurance that was initiated by Cambodian Association for Assistance to Families and Widows (CAAFW) in 2005 to improve health of the pre-poor/ the poor and protect them from health-related crisis.

Program goals/rationale: 

Generalized health risks and barriers to access to care pose one of the greatest threats to Cambodians. Out-of-pocket health expenditures are a widely recognized burden forcing many Cambodians into poverty precisely when they are the most vulnerable.

CBHI is initiated to reduce the financial barriers for pre-poor and poor people who are at risk of health-related crisis to access the quality health service delivery through some mechanisms of the scheme.

Key program components: 

CAAFW communicated and negotiated with local stakeholders (provincial health department, operational health district, referral hospital, health center, local authority and other village health support group) to explore the possibility of and seek their cooperation for the implementation of the scheme. After negotiation, the agreement was that the contracted health center is for first level of health care; referral hospital is for second level of health care while provincial hospital provides third level of health care following the guideline of Ministry of Health. CAAFW involves in the quality control of service delivery by applying some of its own quality control methods. Health facilities at the scheme catchment are subsidized by the government of about 70% so the cost of user fees that CAAFW has to pay for its insured patients represents only 20-30% of the real cost of the care.

CAAFW conducted a feasibility study to make sure that the cost of premium is affordable to majority of the people in the scheme catchment. The total average premium of $3 per insured member per year; the amount of premium to be paid by an insured member is $2 per and 1$ is subsidized by donor funding.

Many approaches have been used to promote the membership by using some key messages and scheme network to make people aware of and join the scheme.
After registration, the insured members are given with CBHI card that can be used to access the defined benefit packages including accessing health services with free of charge, transportation fee to access health facilities and death grant. The scheme beneficiaries are educated on client’s rights and the importance of the CBHI card, and some mechanisms are developed to encourage them to participate in monitoring the health service delivery at contracted public facilities.

Program history: 

Before the initiation of this scheme, CAAFW had piloted three health care financing schemes including Community –Based Health Insurance, Micro Credit in Health and Social Lending to assess the impact of the schemes on affordability of and accessibility to health service delivery by people. After the assessment, CBHI was considered as the most effective and efficient health care financing scheme to be implemented in the Thmor Pourk.

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