Introduction Low- and middle-income countries face major challenges in organising longitudinal care for non-communicable diseases (NCDs). In Cambodia, a pluralistic health system, weak primary care and limited coordination across providers contribute to fragmented care pathways. This study explores how patients and healthcare professionals experience NCDs management and how care is organised across public, private and community settings.Methods We conducted an interpretivist qualitative study using 36 semi-structured interviews with adults living with hypertension, type 2 diabetes or epilepsy, and 3 focus group discussions with 24 healthcare professionals across three Cambodian provinces. Data were analysed using a hybrid inductive–deductive thematic approach with triangulation.Results Care pathways were highly fragmented and non-linear, shaped by symptoms, cost, geographical access and social influence rather than structured referral systems. Limited therapeutic literacy, sociocultural beliefs and fear of long-term medication contributed to poor treatment continuity. Communication gaps between hospitals, primary care, private clinics and community pharmacies resulted in patients carrying medical information between providers. Pharmacists were accessible but under-recognised and weakly integrated into chronic care teams. Financial and logistical barriers further undermined follow-up.Conclusion Fragmented service organisation, weak interprofessional coordination and limited patient education hinder effective NCDs management in Cambodia. Strengthening people-centred care models, integrating pharmacists and nurses into multidisciplinary teams and implementing simple interoperable communication tools could improve continuity, medication safety and patient engagement. These findings highlight the need for system-level reforms that strengthen care coordination, formalise the role of pharmacists and enhance therapeutic education within people-centred NCDs care models.
Introduction Reducing out-of-pocket (OOP) health spending is the headline target of universal health coverage (UHC) reforms, but two questions remain actively debated despite a substantial prior literature on each: does cutting OOP improve population health, and—when reform brings OOP down on average—who in the income distribution still pays OOP?Methods We use a panel of 241 countries (2000–2022), 13 UHC expansion episodes and harmonised microdata from four large national surveys (the Behavioural Risk Factor Surveillance System, Pesquisa Nacional de Saúde, Encuesta Nacional de Ingresos y Gastos de los Hogares, National Health and Nutrition Examination Survey). Estimators include two-way fixed effects (TWFE), synthetic difference-in-differences, Callaway-Sant’Anna staggered difference-in-differences (DID) and wild cluster bootstrap inference for the small-group TWFE.Results A one percentage point (pp) increase in the OOP share is associated with 0.16 additional infant deaths per 1000 (p=0.003), robust to income-growth, inequality and health-spending controls. TWFE estimates a 5.9 pp average OOP reduction across UHC episodes (p=0.024); synthetic DID yields a more conservative 3.3 pp (p=0.039), with Indonesia (−10.8 pp), Rwanda (−8.7 pp) and China (−5.3 pp) driving the pooled effect while Mexico (−0.3 pp) and Chile (−1.6 pp) show small short-run changes. In the USA and Brazil, the income gradient in poor health is steep and pro-poor in both self-reported and clinically measured biomarkers (hypertension, diabetes, obesity); in Mexico, catastrophic OOP spending displays a ‘reverse gradient’ concentrated among upper-income households who self-finance private care.Conclusion Universal coverage on paper does not mechanically deliver universal coverage in practice. The institutional design of where residual OOP falls is at least as policy-relevant as the headline magnitude of any OOP reduction.
