BACKGROUND As elsewhere in low- and middle-income countries, due to limited fiscal resources, universal health coverage (UHC) remains a challenge in Cambodia. Since 2016, the National Social Security Fund (NSSF) has implemented a social health insurance scheme with a contributory approach for formal sector workers. However, informal sector workers and dependents of formal sector workers are still not covered by this insurance because it is difficult to set an optimal amount of contribution for such individuals as their income levels are inestimable. The present study aims to develop and validate an efficient household income-level assessment model for Cambodia. We aim to help the country implement a financially sustainable social health insurance system in which the insured can pay contributions according to their ability. METHODS This study will use nationally representative data collected by the Cambodia Socio-Economic Survey (CSES), covering the period from 2009 to 2019, and involving a total of 50,016 households. We will employ elastic net regression analysis, with per capita disposable income based on purchasing power parity as the dependent variable, and individual and community-level socioeconomic and demographic characteristics as independent variables. These analyses aim to create efficient income-level assessment models for health insurance contribution estimation. To fully capture socioeconomic heterogeneity, sub-group analyses will be conducted to develop separate income-level assessment models for urban and rural areas, as well as for each province. DISCUSSION This research will help Cambodia implement a sustainable social health insurance system by collecting optimal amount of contributions from each socioeconomic group of the society. Incorporation of this approach into existing NSSF schemes will enhance the country's current efforts to prevent impoverishing health expenditure and to achieve UHC.

中文翻译：

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在柬埔寨实施可持续健康保险系统：一项研究协议，用于开发和验证有效的家庭收入水平评估模型，以公平地收取保费。

背景技术与低收入和中等收入国家的其他地方一样，由于财政资源有限，全民健康覆盖（UHC）仍然是柬埔寨的一项挑战。自2016年以来，国家社会保障基金（NSSF）实施了一项社会健康保险计划，对正规部门工人采取了分担方式。但是，非正规部门的工人和正规部门的工人的家属仍未包括在该保险之内，因为难以估计此类人的最佳缴费额，因为他们的收入水平是无法估计的。本研究旨在为柬埔寨开发和验证有效的家庭收入水平评估模型。我们旨在帮助该国实施财务上可持续的社会健康保险制度，使被保险人可以根据自己的能力缴纳费用。方法本研究将使用柬埔寨社会经济调查局（CSES）收集的具有全国代表性的数据，涵盖2009年至2019年，涉及50,016户家庭。我们将采用弹性净回归分析，将基于购买力平价的人均可支配收入作为因变量，将个人和社区一级的社会经济和人口特征作为自变量。这些分析旨在为健康保险缴费估算创建有效的收入水平评估模型。为了充分把握社会经济的异质性，将进行子组分析，以针对城市和农村地区以及每个省制定单独的收入水平评估模型。讨论本研究将通过收集社会中每个社会经济群体的最优供款额来帮助柬埔寨实施可持续的社会健康保险体系。将该方法纳入现有的NSSF计划将加强该国目前为防止贫困的卫生支出和实现UHC而做出的努力。