ArticleInternational journal for equity in health2023
Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia.
Article in International journal for equity in health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- The impact of family health resources on the economic risk of diseases in rural China: based on a path analysis.BMC public health · 2026Article
- Health Shocks and Debt Risk Among Middle-Aged and Elderly Individuals in China: The Mediating Roles of Informal Self-Treatment and Formal Healthcare Utilization.Risk management and healthcare policy · 2026Article
- Self-care and health seeking for diabetes and hypertension in Cambodia.Health policy and planning · 2025Article
- Determinants of distress financing for healthcare service utilization: a convergent mixed-method study at a tertiary hospital in Malaysia.Health policy and planning · 2025Article
- Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia.Health economics review · 2022Article
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6 authors.
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Abstract
backgroundFinancial risk protection is a core dimension of universal health coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. Increasing indebtedness and high interest rates, particularly among unregulated money lenders, can lead to a vicious cycle of poverty and exacerbate inequity.
methodsTo inform efforts to improve Cambodia's social health protection system we analyze 2019-2020 Cambodia Socio-economic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. In addition, we calculate a direct economic measure to facilitate the regular monitoring and reporting on the devastating burden of excessive out-of-pocket expenditure for policy makers.
resultsMore than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to US$ 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is US$ 250.8 million or 0.9% of GDP.
conclusionsSuch losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders. These measures could strengthen social health protection by enhancing financial risk protection, mitigating vulnerability to the devastating economic effects of health shocks, and reducing inequities.
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