This study analyzes how healthcare, health, and social factors contribute to high out-of-pocket health expenditures (OOPE) among informally employed Cambodian households without prepayment schemes, finding that healthcare-related factors are the largest drivers of financial hardship. The authors recommend expanding prepayment schemes focused on comprehensive outpatient care, essential medications, and higher-level services, while also addressing noncommunicable diseases and injuries to improve financial protection.