Patterns and factors associated with healthcare utilisation in Cambodia: a cross-sectional study based on the World Health Survey Plus 2023

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Background: The Cambodian government aims to boost healthcare utilisation in public facilities and reduce the spending burden for disadvantaged households. This study aims to describe patterns of public and private outpatient and inpatient healthcare use and investigate the factors associated with public healthcare usage in Cambodia. Method: A cross-sectional study was conducted in all provinces in Cambodia, including the capital, Phnom Penh. The analysis included 4603 individuals aged ≥18 who had received care within the last 12 months. Results: Around 9% of outpatient and 50% of inpatient visits were made to public healthcare facilities. The number of outpatient visits made to public healthcare compared with private healthcare facilities was significantly higher in women (aOR 1.4, 95% CI 1.1, 1.8), living in rural settings (aOR 1.4, 95% CI 1.1, 1.7), those in the poorest (aOR 1.7, 95% CI 1.2, 2.3) and poor (aOR 1.5, 95% CI 1.1, 2.1) compared with the richest wealth quintiles, and respondents with insurance coverage (aOR 2.0, 95% CI 1.6, 2.5). The number of inpatient visits made to public healthcare compared with private healthcare facilities was significantly higher in the poorest (aOR 2.4, 95% CI 1.4, 3.9), poor (aOR 2.4, 95% CI 1.5, 4.0) and middle (aOR 2.5, 95% CI 1.5, 4.1) compared with those in the richest wealth quintiles and respondents with insurance coverage (aOR 2.1, 95% CI 1.5, 3.2). Conclusion: Our study shows that private healthcare dominates outpatient services in Cambodia, while public healthcare is more significant for inpatient care. Individuals with low socioeconomic status and those with insurance showed higher public healthcare utilisation for outpatient and inpatient services, with women more likely to use public outpatient care. To progress towards universal health coverage, it is essential to improve public healthcare quality, especially in rural areas, expand service coverage and social health protection and develop strategies to engage the private sector.

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