For Nau Channy, worries about the exorbitant cost of health care for her family
ended when she thumb-printed a contract that made her a party to an innovative
trial micro-health insurance scheme under way in her Kandal village.
GRET doctor Kim Sophat tends to Khun Srey Neth, 9, at her home.
scheme was initiated by the French NGO GRET as an adjunct to its already
functional micro-finance programs. Launched in September 1998 with $425,000 in
funding, GRET works in partnership with the Ministry of Health in delivering
affordable in-home health care to the residents of Roluos and Tien communes in
Kandal Steung District.
"GRET's doctor comes to see my son at home
[who's] had heart disease since birth," said Channy, a 36-year-old Tien commune
farmer, of the benefits of the program. "Before I sent him to Phnom Penh and
district hospitals that cost me a lot of money. [Now] I spend little money on
medical bills since we became GRET insurance members."
The GRET program
is designed to provide low-income Cambodians with an alternative to having to
finance costly medical treatment by mortgaging their land - a common route to
the burgeoning problem of landlessness in the Kingdom - or consulting lower cost
kru-Khmer (traditional doctors) of doubtful efficacy.
Begun in 1997, GRET
designed the program as a three cycle medical insurance package with initial
annual premiums of 2,000 riels for the introductory first cycle, rising to 6,000
riels for a widely expanded treatment list in the program's current third
"It is too early to say if the project is a success," said Pascale
Le Roy, GRET Project Director. "We are trying to find out the people's need to
make the system sustainable [and] we want the people to understand the insurance
and create a [public health insurance] system which can be generalized in
According to Le Roy, the GRET micro-health insurance program
would have to be fine-tuned for at least another five years to judge its
effectiveness and sustainability.
A new cycle is scheduled to begin in
September, but Le Roy says that an avalanche of complaints about the doubling of
the cost of premiums from cycle two to cycle three - which led to a drop in the
number of subscribing individuals from 771 to 445 - has led GRET to institute a
bi-annual premium of 3,000 riels.
Phan Oun, 45, a Roluos farmer, was one
of those who dropped out of the program after the premiums were raised 3,000
riels to 6,000 riels. Oun said she could only afford to insure five of her nine
family members, but GRET regulations forbade her from doing so.
also critical about the limited hours of participating doctors in the GRET
"Though I personally continue to use the [GRET] system, I still go
to the private clinic because my children have gotten sick at night when the
GRET doctor is not available," Oun said.
But GRET-employed doctor Kim
Sophat defends the GRET system for delivering a level of care that hospitals and
clinics can't: home visits by professionals.
Each morning, a GRET medical
insurance agent goes house-to-house in the participating communes to check for
villagers in need of medical attention. A GRET doctor is later dispatched to
deliver personal care in the afflicted person's home.
Khun Saveth, a
single mother with a daughter to care for, says the quality of medical attention
she receives under the GRET plan is worth the premiums she pays.
I went to hospital [only] when I got seriously sick,"
Saveth said. "But now
even minor problems get treated because the doctor comes to visit my house every