Socioeconomic and geographic inequalities in unmet healthcare needs in Cambodia: evidence from a national cross-sectional study

Abstract Introduction Despite economic growth and health system improvements in Cambodia, inequalities in access to healthcare services persist. Unmet healthcare needs provide a key indicator of equity in health service access. This study examined the association between socioeconomic position (SEP) and unmet healthcare needs among Cambodian adults and assessed whether these associations differed by residential area. Method We conducted a cross-sectional analysis of nationally representative data from 5,001 adults aged ≥ 18 years in Cambodia who participated in the 2023 World Health Survey Plus (WHS+). Unmet healthcare need was defined using three specifications: (1) not receiving healthcare despite reported need; (2) not receiving healthcare or receiving care from a non-medical facility; and (3) not receiving healthcare or receiving care from a non-medical facility or private pharmacy. SEP was derived using principal component analysis conducted separately for urban and rural households and categorized into tertiles. Survey-weighted multivariable logistic regression examined associations between SEP and unmet healthcare needs stratified by residential area. Results The prevalence of unmet healthcare needs ranged from 7.6% to 42.8%, depending on the definition used. In urban areas, no statistically significant associations between SEP and unmet healthcare needs were observed across specifications. In rural areas, low-SEP individuals had significantly higher odds of unmet healthcare needs under Specification 2 (aOR = 2.40, 95% CI: 1.06–5.41), while middle-SEP individuals had lower odds under Specification 3 (aOR = 0.63, 95% CI: 0.41–0.96). Predicted probabilities varied across SEP and residential area, with patterns differing depending on outcome specifications, particularly in the urban area. Conclusion Unmet healthcare needs in Cambodia show persistent socioeconomic and geographic inequalities, which are more evident when defined by access to formal providers. Self-reported measures may underestimate these disparities. Policies should prioritize strengthening affordable rural primary care, regulating private pharmacies, and improving financial protection for disadvantaged populations.