SKY History

The origins of SKY (Sokapheap Krousar Yeung, “Health for Our Families”) lie in a microfinance program launched by Groupe d’échange et de recherche technologiques (GRET) in Cambodia in 1991. Observing that borrowers frequently cited health problems as a reason for dropping out of the program, GRET began to develop a micro-insurance product aimed at mitigating the disastrous consequences of health shocks. Piloted in 1998 and expanded in subsequent years, SKY offers households, for a fixed monthly premium, free and unlimited primary and emergency care at contracted public health facilities, as well as a number of other health services. One of SKY’s primary goals is to enable families to cover health costs without risking impoverishment. SKY typically represents the only health insurance option available in the regions it operates.

SKY currently offers insurance to households in several rural districts in four provinces (Takeo, Kandal, Kampong Thom and Kampot) and the capital, Phnom Penh. Currently, the program has 39 091 beneficiaries from 7,900 households.

The SKY Impact Evaluation

The SKY evaluation will include both a qualitative component and, building on lotteries for coupons that SKY already uses as a marketing tool, a quantitative randomized controlled trial. The central methodological tool of this evaluation is randomized distribution of “Lucky Draw” coupons of different values that will induce random variation in the likelihood of taking up insurance. Randomization allows estimation of the causal effects of health insurance as distinct from all other characteristics that vary across insured and non-insured households. In-depth interviews of a sample of households in selected villages will be used to take a closer look at household behavior. Finally, interviews with households, health center staff, and SKY Member Facilitators will help to understand SKY’s effects on health centers.

In addition to funding the SKY program itself, AFD and other donors have provided funds for Scientific Evaluation for Global Action (SEGA) at the University of California, Berkeley to evaluate how well SKY is achieving its goals. SEGA’s mission is to improve development outcomes by identifying what programs are working and understanding why. SEGA has partnered with the Royal University of Phnom Penh and Domrei Research and Consulting.

Domrei Research and Consulting is responsible for:

• Ensuring that the lucky draw coupons are administered correctly and fairly.
• Creating and conducting X household surveys for the baseline, midline, and end line of the evaluation.
• Conducting qualitative interviews from seven carefully selected villages in Kandal and Takeo in order to better understand why people purchase.
• Logbooks
• Others

Objectives of the Study

The research has four objectives:

1. To estimate the causal effect of health insurance on households:

• Economic outcomes (e.g., medical spending; sales of productive assets; household debt and loans)
• Health outcomes (e.g., frequency and duration of illness; subjective self-health assessments; objective health measures)
• Health utilization (e.g., public health facility utilization; substitution to public facilities from private health centers and traditional medicine; preventative care utilization; timely utilization of curative care; self-medication)

2. To understand the determinants of take-up of health insurance; the extent of adverse and positive selection; and the potential for risk-pooling.

• Household characteristics (e.g., wealth and income; age and sex composition; past health utilization; health status; perceptions of public facilities; expected utilization of public facilities; access to alternate sources of health financing; risk aversion)
• Public health facility characteristics (e.g., objective measures of quality; convenience of access)

3. To identify potential effects of health insurance on public health facilities (e.g., hours and drug availability; subjective and objective quality indicators).

4. To contribute to the body of knowledge on health insurance in Cambodia and in developing countries more broadly.

Further Reading on SKY:

• SKY Evaluation Protocol
• Results of the first Health Center Survey