INTRODUCTION

This chapter is based on a research paper that aimed to analyse various mechanisms of health care delivery, both in theory and in practice, in order to suggest appropriate mechanisms for a social health insurance (hereafter SHI) scheme. The main question addressed by the chapter therefore concerns government policy for health care delivery when the SHI scheme is implemented in 2015. Should the government engage private providers in delivering services to the insured by allowing the SHI scheme to contract with private providers, or should it instead invest in building more health facilities and recruiting more staff for public facilities? Although providing services through public facilities would reduce transaction costs, building more public facilities to accommodate rising demand adequately would not be feasible and would consume a lot of time and resources.

When we take into account (i) the intention of the government, (ii) the behaviour of health service users and (iii) the capacity of public facilities, the proposition that the private sector should be engaged in the delivery of health services to the insured under the SHI scheme is convincing.

The 2005 Master Plan for Social Health Insurance in Cambodia articulated an intention to encourage private providers to contract with insurance schemes as soon as an accreditation system is established (MoH 2005). The master plan, however, stated clearly that the package will initially cover only services delivered by public providers within the province, meaning that neither national hospitals nor private facilities will be covered under those insurance schemes (MoH 2005) currently. The engagement of private sector service providers, therefore, depends on how soon an accreditation system is put in place.

As for the behaviour of health service users, research in 2006 found that the utilization rate of public facilities to seek first treatment was very low, accounting for only 22 per cent, while that of the private sector accounted for 69 per cent1 (48 per cent used private hospitals, clinics, pharmacies, and private consultations and 21 per cent used non-medical shops and outlets) (National Institute of Public Health 2006).2 Such a low utilization rate reflects low trust in and satisfaction with public facilities.