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Amid the global pandemic of a novel Coronavirus Disease 2019 (COVID-19), healthcare delivery system is being stretched. In Japan, rapid spread of the epidemic brings hospitals to the brink of exhaustion. This commentary aims to briefly review related policies of Japan in managing healthcare delivery system. Among the relevant actions, strengthening the hospitalized care is emphasized to save lives. Despite of limitations, the policies show a success in preventing a collapse of healthcare delivery system and skyrocketing mortality from happening so far. On the other hand, huge concerns remain if the infections continue to rapidly increase. The experience in Japan indicates the urgency of planning of healthcare delivery system, mobilizing all relevant social sectors by consensus, and guiding people with calm manner based on the best shared knowledge and evidences.

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.