In Cambodia, many high-ranking government officials and public figures seek medical treatment abroad – including Prime Minister Hun Sen.

With this in mind, it is not surprising that many locals also seem to often distrust local healthcare facilities.

Cambodia has one of the fastest growing economies in the region.

Last year, the country saw another year of seven per cent GDP growth, and such trends have led to an increase in national wealth and living standards.

Despite this rapid development, more and more people are going abroad to access healthcare services.

The number of outbound Cambodians travelling for medical purposes and holidays in general rose from 1.2 million in 2015 to 1.4 million in 2016, out of a population of 15.76 million.

Between 24 and 30 per cent of Cambodian tourists travel to Vietnam and Thailand for such purposes.

However, no complete set of statistics examining the total number of Cambodians seeking medical care abroad is presently available.

According to Jiaranai Boonprasatsuk, marketing director of the heart centre at Phyathai 2 Hospital in Bangkok, Cambodians are the number one nationality among foreign patients receiving medical treatment at the hospital in recent years.

This is a concern, given the negative implications for the national healthcare system.

The Health Strategic Plan 2016-20 reveals that there are approximately 1,000 public healthcare facilities and 8,000 private healthcare facilities or providers across Cambodia.

This seems to imply that policy-makers have attached a greater importance on the quantity of providers rather than the quality of care.

In reality, these health facilities lack sufficient human capital and resources, which prevents them from meeting the needs and expectations of the population.

According to a recent study, public health facility users complained of a lack of hygiene and the high cost of service at Cambodia’s local hospitals.

Secretary of state at the Ministry of Health Dr Heng Taikry has acknowledged that while some hospitals, such as Phnom Penh’s Calmette, have equipment on a par with that found in Singapore, there are not enough qualified staff to ensure a high level of treatment.

The problem is particularly acute in rural areas – communities living near the borders of neighbouring countries often travel abroad if they cannot find doctors in their own areas.

The prime minister himself remarked during the closing ceremony of the ministry’s annual conference: “We must not forget the people who live near the borders. They seek treatment in bordering countries because there are no doctors in their areas.”

In March, he also acknowledged the lack of specialised doctors stationed in rural areas and instruc-ted the Ministry of Health to deploy greater resources to these parts of the country.

All things considered, the government should seriously consider increasing budget appropriations to the health sector.

The 2019 budget only allocated $455 million to healthcare, a decrease of $30 million from 2018.

There has been significant growth in the number of modern health facilities, such as the Royal Phnom Penh hospital, Sunrise hospital, Khema hospital and others.

Questionable ethics

The Royal Phnom Penh and Sunrise hospitals are equipped with advanced equipment that meets international standards.

Developed by foreign firms, these hospitals have not only introduced international standards to the Kingdom, but also brought in highly skilled medical staff from Thailand, the US, France and Japan.

Khema International Polyclinic is Cambodian-owned, and its director, Dr Oum Sopheap, said: “We will try our best to provide quality care, just as good as in those countries. We also cooperate with doctors and specialists abroad as our partners.”

This implies that the Cambodian population could have access to hospitals that meet higher standards.

Nevertheless, it is clear that some still prefer to seek medical treatment abroad – and there is no doubt that this has become easier over the years.

Asean nations have contributed to increasing accessibility to foreign medical services, with regional integration allowing people to travel between member countries without visas.

Flights are also now shorter and more affordable, further facilitating outbound medical travel.

But importantly, this trend indi-cates a lack of trust in local health-care facilities.

The questionable nature of professional ethics among doctors and codes of medical conduct are of the greatest concern for Cambodian patients.

Noting the current deficiencies in the healthcare sector in remarks at the same Ministry of Health conference last year, the prime minister stated: “We acknowledge the shortcomings and the use of bad words by some doctors, but not in terms of the healthcare sector as a whole.”

He added that healthcare institutions should treat patient equally regardless of a patient’s income.

In a recent case, a doctor was found to have charged a farmer $5,000 for treating his two children who had contracted dengue fever, sparking public anger as to extortive practices by a private practitioner.

The case demonstrated that the rise of boutique, private health facilities could enable doctors to earn profit from their profession in dishonest ways, allowing them to overcharge or mislead patients for their own financial benefit.

Moreover, some physicians have been found to exaggerate patient diagnoses or provide false information if it proves beneficial to them.

One man told The Phnom Penh Post that he had sought medical care in Thailand because he did not trust Cambodian doctors.

He was told by one that he required surgery, so he decided to travel to a hospital in Surin province in Thailand for a second opinion.

The doctor there said he only needed a simple set of prescription drugs.

Losing trust

Patients have even died due to the carelessness of doctors.

In 2016 a private clinic was closed after the sudden death of a man who had received injections for back pain – underscoring the urgent need for reform.

Ironically, while many Cambodians travel abroad for medical reasons, the Kingdom has become something of a regional dental hub, attracting people from across Southeast Asia to receive treatment in the Kingdom.

With dentistry costing much less than in neighbouring countries – often up to as much as 70 per cent cheaper – Cambodia has gained a reputation as a major dental tourism destination.

While instances of neglect in Cambodia’s healthcare system are not very common, particularly notorious cases spread quickly through social media.

This significantly shapes popular perceptions of domestic health facilities in the country – in an extremely negative way.

Cambodians appear to be gradually losing trust in their health service.

Trust plays an important role in healthcare as patients are vulnerable and heavily dependent on a health provider’s treatment decisions.

Losing trust in local doctors directly increases the demand for and the use of health services abroad.

Though doctors may not have bad intentions, such cases reflect the carelessness and unprofessional standards adopted by some private hospitals.

Until more stringent medical standards and regulations are instituted and enforced, Cambodians are likely to continue finding it difficult to trust their own health system.

This is not simply a Cambodian problem, it is prevalent in other less developed countries.

Indonesians, in particular, actively seek medical service overseas – particularly in Malaysia.

Indonesians have spent approximately $11.5 billion a year for medical services abroad according to a recent government report.

The number of Cambodians seeking treatment abroad is an important signal that something is wrong in contemporary Cambodian healthcare.

Rebuilding trust in local health providers will be a long and arduous process.

Initiatives to address the root causes of the problem by increasing investment in human resources together with the development of stricter codes of conduct governing the actions of medical staff need to be implemented.

The regulation of private health providers regarding the cost of their services should also be strengthened.

Finally, greater research on the topic is urgently needed in order to develop a truly data-driven set of policy solutions.

Tang Vouchnea is a Young Research Fellow at Future Forum, an independent public policy think tank based in Phnom Penh. She is currently conducting a research project on the feasibility of universal health coverage in Cambodia.