Can public hospitals be pro-poor? The health equity fund experience in Cambodia

In many low-income countries, poor households face many barriers to use hospital services. As a result, better-off households may be the main beneficiaries of government and donor subsidies to public hospitals. We aimed to assess the extent to which health equity funds could improve access by the poor to public hospitals. This study reports the results of a benefitincidence analysis carried out in six rural hospitals in Cambodia. In each site, a bed census survey has been conducted in order to assess the socioeconomic status of the inpatients. Through an asset index we compare the profile of inpatients with the profile of the general population. In the six hospitals, the socio-economic profile of inpatients is quite similar to the rural population’s profile. HEF probably contributes to this outcome, but quality of care looks like another feasible pro-poor strategy. Operators of health equity funds do not leak their assistance to non-poor. Problematic however is that some poor inpatients did not get support from the scheme. This study shows that inequity in hospital utilization can be tackled through waiver schemes.