IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v367y2025ics0277953625001121.html
   My bibliography  Save this article

What contributes to out-of-pocket health expenditure in Cambodia's uncovered population? A distributional and decomposition analysis using survey data

Author

Listed:
  • Kaiser, Andrea Hannah
  • Vorn, Searivoth
  • Ekman, Björn
  • Ross, Marlaina
  • Mao, Sovathiro
  • Koy, Sokunthea
  • Koeut, Pichenda
  • Sundewall, Jesper

Abstract

Out-of-pocket health expenditures (OOPE) are an inefficient and inequitable means of health financing. Identifying the factors driving these expenditures is crucial to design effective prepayment schemes. This study uses Cambodia—a country with high OOPE and prevalent informal employment—as a case study to analyse the relative contributions of healthcare, health, and social factors to OOPE and the OOPE budget share (OOPE as a proportion of total annual household expenditure) across different points in their distribution.

Suggested Citation

  • Kaiser, Andrea Hannah & Vorn, Searivoth & Ekman, Björn & Ross, Marlaina & Mao, Sovathiro & Koy, Sokunthea & Koeut, Pichenda & Sundewall, Jesper, 2025. "What contributes to out-of-pocket health expenditure in Cambodia's uncovered population? A distributional and decomposition analysis using survey data," Social Science & Medicine, Elsevier, vol. 367(C).
    • Handle: RePEc:eee:socmed:v:367:y:2025:i:c:s0277953625001121
    DOI: 10.1016/j.socscimed.2025.117783
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625001121
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.117783?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Kankeu Tchewonpi, Hyacinthe & Saksena, Priyanka & Xu, Ke & Evans, David B, 2013. "The financial burden from non-communicable diseases in low- and middle-income countries: a literature review," MPRA Paper 54534, University Library of Munich, Germany.
    2. World Health Organization & World Bank, 2023. "Tracking Universal Health Coverage," World Bank Publications - Reports 40348, The World Bank Group.
    3. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    4. Andrea Hannah Kaiser & Niccolò Rotigliano & Steffen Flessa & Björn Ekman & Jesper Sundewall, 2023. "Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia," PLOS ONE, Public Library of Science, vol. 18(7), pages 1-31, July.
    5. World Bank Group, 2019. "High-Performance Health Financing for Universal Health Coverage," World Bank Publications - Reports 31930, The World Bank Group.
    6. Sinha, Kompal & Davillas, Apostolos & Jones, Andrew M. & Sharma, Anurag, 2021. "Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data," Economics & Human Biology, Elsevier, vol. 43(C).
    7. Phusit Prakongsai & Supon Limwattananon & Viroj Tangcharoensathien, 2009. "The equity impact of the universal coverage policy: Lessons from Thailand," Advances in Health Economics and Health Services Research, in: Innovations in Health System Finance in Developing and Transitional Economies, pages 57-81, Emerald Group Publishing Limited.
    8. Sergio Firpo & Nicole M. Fortin & Thomas Lemieux, 2009. "Unconditional Quantile Regressions," Econometrica, Econometric Society, vol. 77(3), pages 953-973, May.
    9. Ricardo Bitran, 2014. "Universal Health Coverage and the Challenge of Informal Employment: Lessons from Developing Countries," Health, Nutrition and Population (HNP) Discussion Paper Series 87077, The World Bank.
    10. Sauerborn, R. & Adams, A. & Hien, M., 1996. "Household strategies to cope with the economic costs of illness," Social Science & Medicine, Elsevier, vol. 43(3), pages 291-301, August.
    11. Osnat Israeli, 2007. "A Shapley-based decomposition of the R-Square of a linear regression," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 5(2), pages 199-212, August.
    12. Anthony Shorrocks, 2013. "Decomposition procedures for distributional analysis: a unified framework based on the Shapley value," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 11(1), pages 99-126, March.
    13. Davillas, Apostolos & Jones, Andrew M., 2020. "Regional inequalities in adiposity in England: distributional analysis of the contribution of individual-level characteristics and the small area obesogenic environment," Economics & Human Biology, Elsevier, vol. 38(C).
    14. Gabani, Jacopo & Suhrcke, Marc & Neelsen, Sven & Eozenou, Patrick Hoang-Vu & Smitz, Marc-Francois, 2024. "Does health aid matter to financial risk protection? A regression analysis across 159 household surveys, 2000–2016," Social Science & Medicine, Elsevier, vol. 356(C).
    15. Kaiser, Andrea Hannah & Okorafor, Okore & Ekman, Björn & Chhim, Srean & Yem, Sokunthea & Sundewall, Jesper, 2023. "Assessing progress towards universal health coverage in Cambodia: Evidence using survey data from 2009 to 2019," Social Science & Medicine, Elsevier, vol. 321(C).
    16. repec:plo:pone00:0080343 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Davillas, Apostolos & Jones, Andrew M, 2020. "Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers," Journal of Health Economics, Elsevier, vol. 69(C).
    2. Nie, Peng & Ding, Lanlin & Jones, Andrew M., 2020. "Inequality of Opportunity in Bodyweight among Middle-Aged and Older Chinese: A Distributional Approach," IZA Discussion Papers 13421, Institute of Labor Economics (IZA).
    3. Robson, Matthew & Chen, Gang & Olsen, Jan Abel, 2025. "Explaining subjective social status and health: Beyond education, occupation and income," Social Science & Medicine, Elsevier, vol. 371(C).
    4. Davillas, Apostolos & Jones, Andrew M., 2020. "Regional inequalities in adiposity in England: distributional analysis of the contribution of individual-level characteristics and the small area obesogenic environment," Economics & Human Biology, Elsevier, vol. 38(C).
    5. Gregorio Gimenez & Ana Isabel Gil-Lacruz & Marta Gil-Lacruz, 2021. "Is Happiness Linked to Subjective Life Expectancy? A Study of Chilean Senior Citizens," Mathematics, MDPI, vol. 9(17), pages 1-12, August.
    6. Nikolova, Milena, 2016. "Minding the happiness gap: Political institutions and perceived quality of life in transition," European Journal of Political Economy, Elsevier, vol. 45(S), pages 129-148.
    7. Sonja C. Kassenboehmer & Mathias G. Sinning, 2014. "Distributional Changes in the Gender Wage Gap," ILR Review, Cornell University, ILR School, vol. 67(2), pages 335-361, April.
    8. Sinha, Kompal & Davillas, Apostolos & Jones, Andrew M. & Sharma, Anurag, 2021. "Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data," Economics & Human Biology, Elsevier, vol. 43(C).
    9. Sun, Hongye & Kim, Giseung, 2021. "The composite impact of ICT industry on lowering carbon intensity: From the perspective of regional heterogeneity," Technology in Society, Elsevier, vol. 66(C).
    10. SOLOGON Denisa & ALMEIDA Vanda & VAN KERM Philippe, 2019. "Accounting for the distributional effects of the 2007-2008 crisis and the Economic Adjustment Program in Portugal," LISER Working Paper Series 2019-05, Luxembourg Institute of Socio-Economic Research (LISER).
    11. Davillas, Apostolos & M. Jones, Andrew & Sinha, Kompal & Sharma, Anurag, 2018. "Distributional analysis of the role of breadth and persistence of multiple deprivation in the health gradient measured by biomarkers," ISER Working Paper Series 2018-14, Institute for Social and Economic Research.
    12. Asuyama, Yoko, 2021. "Determinants of job interestingness: Comparison of Japan and other high-income countries," Labour Economics, Elsevier, vol. 73(C).
    13. Nikolova, Milena & Cnossen, Femke, 2020. "What makes work meaningful and why economists should care about it," Labour Economics, Elsevier, vol. 65(C).
    14. Kumara, Ajantha Sisira & Samaratunge, Ramanie, 2017. "Impact of ill-health on household consumption in Sri Lanka: Evidence from household survey data," Social Science & Medicine, Elsevier, vol. 195(C), pages 68-76.
    15. John E. Ataguba & Hyacinth E. Ichoku & Chijioke O. Nwosu & James Akazili, 2020. "An Alternative Approach to Decomposing the Redistributive Effect of Health Financing Between and Within Groups Using the Gini Index: The Case of Out-of-Pocket Payments in Nigeria," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 747-757, December.
    16. Chantreuil, Frédéric & Fourrey, Kévin & Lebon, Isabelle & Rebière, Thérèse, 2021. "Magnitude and evolution of gender and race contributions to earnings inequality across US regions," Research in Economics, Elsevier, vol. 75(1), pages 45-59.
    17. Sowmya Dhanaraj, 2014. "Health Shocks and Coping Strategies: State Health Insurance Scheme of Andhra Pradesh, India," WIDER Working Paper Series wp-2014-003, World Institute for Development Economic Research (UNU-WIDER).
    18. Mohamed Amara & Hatem Jemmali, 2018. "Do Tunisian Young Children Have Equal Chances in Access to Basic Services? A Special Focus on Opportunities in Healthcare and Nutrition," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 11(2), pages 383-403, April.
    19. Dustmann, Christian & Okatenko, Anna, 2014. "Out-migration, wealth constraints, and the quality of local amenities," Journal of Development Economics, Elsevier, vol. 110(C), pages 52-63.
    20. Kerry B. Hudson & Joaquin L. Vespignani, 2014. "Understanding the Deviations of the Taylor Rule: A New Methodology with an Application to Australia," CAMA Working Papers 2014-78, Centre for Applied Macroeconomic Analysis, Crawford School of Public Policy, The Australian National University.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:367:y:2025:i:c:s0277953625001121. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.