High (or low?) dropout rate health insurance Cambodia (06-01-2012)

The 2011 evaluation of the health insurance project in Cambodia, “My Family’s Health”, shows that only 48% of the 2010 members renewed their membership (which is valid for one year). At first this seems very disappointing: Are there cultural barriers? Are the provided health services not sufficient? Are premiums to high? Are the health centers too far from the members’ homes? Or are there other reasons?

All families were asked why they did not extent their membership. The results show that most families cannot pay for the premium anymore (33%). This is very contrasting to the assumption that poverty decreases when people don’t have (high) health expenditures anymore. Furthermore, the maximum premium was carefully calculated by insurance experts of Achmea (Dutch health insurance company) and agreed upon during an assessment among the local population.

Then another factor came across for which was minor media attention: In August the heavy rainfall in the upper Mekong River in Laos and Thailand also led to severe flooding in Cambodia.  It is the worst flooding in more than a decade and left an unprecedented amount of damage in the country. An estimated 400,000 hectares of rice paddies were flooded. Over 250,000 hectares of rice crops were completely lost. 3,000 kilometers of road infrastructures were destroyed. 300-400 kilometers of the dam were damaged. Over 247 were killed. More than 1,000 schools were flooded. The estimated loss could cost Cambodia over $400 million.

In the Peareang district (where the insurance scheme is implemented) 14 people died. Many farmers, who rely on their yearly harvest to make ends meet for the coming year, have lost a full year’s crop. This means that they either have to borrow money to buy seeds or rice, or having to sell the land. The burden of additional costs of transport, caused by the destruction or lack of access to hundreds of kilometers of country roads, of having to buy fodder for the cattle, further threatens the existence of the farmers.

The Cambodian team reported that 67% of the villages around the health centers involved in the programme were flooded. Nearly all crops are destroyed and people have been working very hard to get back on their feet again. It now (January 2012) seems that the renewal of policies is slowly picking up again which might mean people are willing to renew their membership when they have the money. Seen against the dramatic drop in income this is worth looking into: how many people really think that the premium is too high, and how many people did not renew because they were suffering the effects of the flood? And the fact that 52% of the families renewed their membership despite the floods, is perhaps something to be proud of.

Throughout the coming year we will see if renewal rates will increase again, while keep on working on the quality of health services and monitoring all aspects of the programme.