DETERMINANTS OF NATIONAL HEALTH INSURANCE RETENTION AMONG INFORMAL WORKERS IN PHNOM PENH, CAMBODIA
DOI:
https://doi.org/10.17501/26138417.2025.8107Keywords:
Cambodia, informal workers, national health insurance, retention, universal health coverage, social health insuranceAbstract
This study aimed to investigate the determinants of Retention in National Health Insurance (NHI) in Cambodia, among the informal workers in Phnom Penh, Cambodia. Surveys of 424 informal workers in Phnom Penh from September to October 2024 were conducted. Multivariate logistic regression analyses were performed to assess the factors associated with NHI retention among the informal workers. The results revealed that having completed secondary school or higher, working in industrial or service sectors, perceiving high technical and interpersonal quality of healthcare, perceiving comprehensive benefit coverage, and perceiving good availability of healthcare services were significantly associated with retention in the NHI scheme. Additionally, participants with a good level of knowledge about the benefit package were more likely to maintain active membership. It was concluded that while socio-economic and accessibility factors play a critical role, motivational and ability-related factors, such as knowledge of benefit packages, positive perceptions of service quality, and attitudes toward coverage, substantially influence informal workers’ decision to remain enrolled in the scheme. Improving awareness of benefit entitlements and promoting the technical and interpersonal aspects of healthcare quality through targeted health education interventions may enhance NHI retention among informal workers.
Downloads
References
Acharya, A., Vellakkal, S., Taylor, F., Masset, E., Satija, A., Burke, M., & Ebrahim, S. (2012). Impact of national health insurance for the poor and the informal sector in low and middle-income countries: a systematic review.
Khan, J. A., & Ahmed, S. (2013). Impact of educational intervention on willingness-to-pay for health insurance: A study of informal sector workers in urban Bangladesh. Health Econ Rev, 3(1), 12. doi:10.1186/2191-1991-3-12
Alhassan, R. K., Duku, S. O., Janssens, W., Nketiah-Amponsah, E., Spieker, N., van Ostenberg, P., . . . Rinke de Wit, T. F. (2015). Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana. PLoS One, 10(10), e0140109. doi:10.1371/journal.pone.0140109
Gera, R., Narwal, R., Jain, M., Taneja, G., & Gupta, S. (2018). Sustainable Development Goals: Leveraging the Global Agenda for Driving Health Policy Reforms and Achieving Universal Health Coverage in India. Indian J Community Med, 43(4), 255-259. doi:10.4103/ijcm.IJCM_41_18
Wang, H., Torres, L. V., & Travis, P. (2018). Financial protection analysis in eight countries in the WHO South-East Asia Region. Bull World Health Organ, 96(9), 610-620e. doi:10.2471/blt.18.209858
Ayanore, M. A., Pavlova, M., Kugbey, N., Fusheini, A., Tetteh, J., Ayanore, A. A., . . . Groot, W. (2019). Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana. Health Econ Rev, 9(1), 39. doi:10.1186/s13561-019-0255-5
Erlangga, D., Suhrcke, M., Ali, S., & Bloor, K. (2019). The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One, 14(8), e0219731. doi:10.1371/journal.pone.0219731
Kwon, S., & Keo, L. (2019). Social health protection in Cambodia: Challenges of policy design and implementation. International Social Security Review, 72(2), 97-111.
Nketiah-Amponsah, E., Alhassan, R. K., Ampaw, S., & Abuosi, A. (2019). Subscribers' perception of quality of services provided by Ghana's National Health Insurance Scheme - what are the correlates? BMC Health Serv Res, 19(1), 196. doi:10.1186/s12913-019-4023-3
Nsiah-Boateng, E., Nonvignon, J., Aryeetey, G., Salari, P., Tediosi, F., Akweongo, P., & Aikins, M. (2019). Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: A cross-sectional study. Health economics review, 9. doi:10.1186/s13561-019-0241-y
Ogundeji, Y. K., Akomolafe, B., Ohiri, K., & Butawa, N. N. (2019). Factors influencing willingness and ability to pay for social health insurance in Nigeria. PLoS One, 14(8), e0220558. doi:10.1371/journal.pone.0220558
Yusuf, H. O., Kanma-Okafor, O. J., Ladi-Akinyemi, T. W., Eze, U. T., Egwuonwu, C. C., & Osibogun, A. O. (2019). Health Insurance Knowledge, Attitude and the Uptake of Community-Based Health Insurance Scheme among Residents of a Suburb in Lagos, Nigeria. West Afr J Med, 36(2), 103-111.
Sanogo, N. d. A., Fantaye, A. W., & Yaya, S. (2019). Universal health coverage and facilitation of equitable access to care in Africa. Frontiers in Public Health, 7, 102.
Ashagrie, B., Biks, G. A., & Belew, A. K. (2020). Community-Based Health Insurance Membership Dropout Rate and Associated Factors in Dera District, Northwest Ethiopia. Risk Manag Healthc Policy, 13, 2835-2844. doi:10.2147/rmhp.S277804
Chaleunvong, K., Phoummalaysith, B., Phonvixay, B., Sychareun, V., Durham, J., & Essink, D. R. (2020). Factors affecting knowledge of National Health Insurance Policy among out-patients in Lao PDR: an exit interview study. Glob Health Action, 13(sup2), 1791414. doi:10.1080/16549716.2020.1791414
Dartanto, T., Halimatussadiah, A., Rezki, J. F., Nurhasana, R., Siregar, C. H., Bintara, H., . . . Yuan, E. Z. W. (2020). Why do informal sector workers not pay the premium regularly? Evidence from the National Health Insurance System in Indonesia. Applied Health Economics and Health Policy, 18, 81-96.
Kolesar, R. J., Pheakdey, S., Jacobs, B., Chan, N., Yok, S., & Audibert, M. (2020). Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations. International Social Security Review, 73(1), 35-63
Tandon, A., Oliveira Cruz, V., Bhatnagar, A., Wang, H., Haque, T., & Jhalani, M. (2021). Financing health care in the WHO South-East Asia Region: time for a reset. WHO South-East Asia Journal of Public Health, 10(Suppl 1), S63-S72. doi:10.4103/2224-3151.309879
James, N., & Acharya, Y. (2022). Increasing Health Insurance Enrollment in Low- and Middle-Income Countries: What Works, What Does Not, and Research Gaps: A Scoping Review. Inquiry, 59, 469580221090396. doi:10.1177/00469580221090396
Raghupathi, V., & Raghupathi, W. (2020). The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015. Archives of Public Health, 78(1), 20. doi:10.1186/s13690-020-00402-5
Kolesar, R. J., Bogetoft, P., Chea, V., Erreygers, G., & Pheakdey, S. (2022). Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia. Health economics review, 12(1), 10. doi:10.1186/s13561-021-00354-8.
Mensah, O., & Yeboah, R. (2022). Assessing the Impact of Education on the Uptake of Health Insurance at the Cape Coast Technical University, Ghana. E-Journal of Humanities Arts and Social Sciences, 3 Issue 12, 556-571. doi:10.38159/ehass.20223124
Rahman, T., Gasbarro, D., & Alam, K. (2022). Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst, 20(1), 83. doi:10.1186/s12961-022-00886-3
Adjei-Mantey, K., & Horioka, C. Y. (2023). Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis. Review of Economics of the Household, 21(4), 1269-1288. doi:10.1007/s11150-022-09621-x
Deresse, T., Eshete, A., Mulatu, H., & Dessalegn, M. (2023). Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study. Ethiop J Health Sci, 33(5), 781-794. doi:10.4314/ejhs.v33i5.8
Domapielle, M. K., Dassah, C., Dordaa, F., Cheabu, B. S. N., & Sulemana, M. (2023). Barriers to health care access and utilization among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP): the perspective of users and service providers in north-western Ghana. Prim Health Care Res Dev, 24, e48. doi:10.1017/s1463423623000385
Fund, N. S. S. (2023). National Social Security Fund-Annual-Report 2023. Retrieved from
Lim, M. Y., Kamaruzaman, H. F., Wu, O., & Geue, C. (2023). Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health, 81(1), 148. doi:10.1186/s13690-023-01159-3
Manet, H. E. H. (2023). regulation in contribution payment in Cambodia.
Toleha, H. N., & Bayked, E. M. (2023). Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis. BMC Public Health, 23(1), 2425. doi:10.1186/s12889-023-17351-7
Trisnasari, Laosee, O., Rattanapan, C., & Janmaimool, P. (2023). Assessing the Determinants of Compliance with Contribution Payments to the National Health Insurance Scheme among Informal Workers in Indonesia. Int J Environ Res Public Health, 20(23). doi:10.3390/ijerph20237130
Fund, N. S. S. (2024). National Social Security Fund- Internal report. Retrieved from
Nsiah-Boateng, E., Akweongo, P., Nonvignon, J., & Aikins, M. (2024). Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey. BMC Health Services Research, 24(1), 546. doi:10.1186/s12913-024-11025-9
GOV. (2024). Roadmap towards universal health coverage in Cambodia 2024-2035.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Nimol Kheng
This work is licensed under a Creative Commons Attribution 4.0 International License.
