Healthcare utilization and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

ABSTRACT Objective To assess utilization of public and private healthcare, related healthcare expenditure, and associated factors for people with type 2 diabetes (T2D) and/or hypertension (HTN) and for people without those conditions in Cambodia. Methods A cross-sectional household survey. Settings Five operational districts in Cambodia. Participants Data was from 2,360 participants aged ≥ 40 years who had used healthcare services at least once in the three months preceding the survey. Primary and secondary outcome The main variables of interest were the number of healthcare visits and healthcare expenditure in the last three months. Results The majority of healthcare visits took place in the private sector. Only 22.0% of healthcare visits took place in public healthcare facilities: 21.7% in people with HTN, 37.2% in people with T2D, 34.7% in people with T2D plus HTN, and 18.9% in people without the two conditions ( P -value<0.01). In people with T2D and/or HTN, increased public healthcare use was significantly associated with Health Equity Fund (HEF) membership and living in operational districts with community-based care . Furthermore, significant healthcare expenditure reduction was associated with HEF membership and using public healthcare facilities in these populations. Conclusion Overall public healthcare utilization was relatively low; however, it was higher in people with chronic conditions. HEF membership and community-based care contributed to higher public healthcare utilization among people with chronic conditions. Using public healthcare services regardless of HEF status reduced healthcare expenditure, but the reduction in spending was more noticeable in people with HEF membership. To increase public healthcare utilization among people with T2D and/or HTN, the public healthcare system should further improve care quality, expand social health protection, and expand community-based care for this population. However, these may require more time and resources. One potential strategy in the short run is to partner the private sector with the public sector. STRENGTHS AND LIMITATIONS OF THIS STUDY ▪ Our study is among the few to examine healthcare utilization and expenditure among people with two major chronic conditions type 2 diabetes (T2D) and/or hypertension (HTN) in Cambodia, in comparison with the people without the two conditions. ▪ The findings in this study provides could inform decision-makers about strategies for T2D and HTN management in Cambodia and similar settings. ▪ Our study is not representative for the national level as most of the study sites we selected were rural or semi-rural. ▪ We only calculated the healthcare expenditure for those who used the service in the three months preceding the study, which cannot be generalized to the target population in the study (people aged 40 years or older).