Medical tourism highlights a changing prognosis for the Kingdom’s healthcare

Gerald Flynn

Many patients still seek treatment from abroad for a variety of ailments

Many patients still seek treatment from abroad for a variety of ailments

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Last month saw Prime Minister Hun Sen pictured sporting a blue hospital gown as he recovered in Singapore following surgery for an undisclosed problem with his shoulder.

While this prompted many to wish the 67-year-old leader a swift recovery, for others it prompted a dialogue on the growing disparity between rich and poor.

It is, perhaps, telling when the lack of medical care in almost every field makes people shun theiir native medical system, which is somkewhat still in its infancy, despite making great strides with foreign assistance, in favour of an overseas hospital.

But, according to experts, this option is becoming more popular with Cambodians.

Consistent economic growth has created a burgeoning middle class in the Kingdom and those with the money do appear to seek treatment abroad.

This is hardly a new phenomenon for any developing country and, as the Kingdom makes rapid gains in catching up with the region and, indeed, the world, locally available healthcare is set to improve.

Just this week four police officers from the Prek Chak International Immigration checkpoint were killed and another seriously injured as their SUV ploughed into the back of a cement truck on National Road 33 in Kampot province’s Toek Cchou district. While three perished at the scene, a fourth died en route to a provincial referral hospital, where the sole survivor of the crash was immediately prepared for medical transit to Vietnam for treatment.

This was hot off the back of another tragedy that left one dead and 13 people injured following a petrol explosion in Siem Reap. Among the wounded were two foreigners – a British and a US citizen – both teachers, who were sent to Thailand for treatment along with another five of the injured who had suffered the worst burns.

The need for increased capacity within Cambodia’s healthcare system is underscored by fatal events like this that are sadly commonplace in the Kingdom.

Medical tourism is apparently becoming a multi-billion-dollar industry, but even putting a true value on the sector is a struggle globally – in part because few countries record the number of tourists crossing their borders for medical treatment.

Notable revenue rise

According to Maureen Lyons of the Joint Commission International – a medical accrediting body with a network boasting 1,090 organisations worldwide – “Thailand, South Korea, Singapore and Malaysia collect data around international patients and country of origin.”

Lyons notes that “Travellers from Cambodia would be mostly seen in Thailand and Vietnam’s statistics – we have one accredited hospital in Cambodia and it’s operated by Thailand behemoth hospital operator BDMS [Bangkok Dusit Medical Services Public Co Ltd] and I believe most of their patients are locals/Cambodians.

“Personally, my experts believe that people travelling to seek medical treatment is on the rise but more specifically concentrated around a number of countries,” she adds.

BDMS is the leading private healthcare provider in Thailand and, in their 2018 annual report, they highlight a notable rise in revenue generated from Cambodian patients across all their facilities.

“International patients’ growth were driven mainly from an increase in Kuwaitis 26 percent year-on-year, Cambodians 23 percent year-on-year and Chinese patients 20 percent year-on-year.”

The private medical group also revealed that they have seen a double digit increase in Cambodia, Laos, Myanmar and Vietnam (CLMV) patients each year for the past five years.

Driving growth abroad

Meanwhile global audit, tax and advisory network KPMG’s 2018 industry focus report on medical tourism in Thailand suggests more growth to come. “It was forecasted that in 2017 international patients will generate THB 48 to 49 billion [$1.55 to 1.58 billion] income for private hospitals, representing a 3 percent to 4 percent growth from the previous year.

The report continues to state: “The number of international patients is expected to increase to 2.4 to 3.3 million through medical tourism and expats residing in Thailand. Moreover, medical tourism is forecasted to support the growth of the tourism sector at around 16 percent per year during 2017- to 2020.”

Research fellow at the independent think-tank Future Forum and author of an op-ed piece on medical tourism in Cambodia, Tang Vouchnea, explains the limitations of much of the data available.

“Regarding the data of Cambodians going abroad for medical services and holiday from 1.2 million in 2015 to 1.4 million in 2016, I took the data from the Tourism Statistic Report 2016. The report only provided the number of Cambodian outbound tourists leaving for various purposes, not only medical check-ups, but also holiday.”

By contrast, 2017 saw some 1.75 million Cambodians leave the country, with that figure reaching 1.99 million by 2018 – although there is no way of knowing how many of these tourists left the Kingdom with the express intention of seeking medical treatment.

Noting that her research found a $30 million cut in Ministry of Health funding from 2018 to 2019’s $455 million, Vouchnea also highlighted the limited supply of public healthcare providers – just 1,000 – compared with the 8,000 private healthcare facilities nationwide.

‘Lack of trust’

“People still prefer medical services abroad because they tend to trust healthcare facilities abroad more than Cambodia’s,” adds Vouchnea.

Speaking with Capital Cambodia on the condition of anonymity, one senior doctor at a BDMS facility explains that the lack of trust in local healthcare and medical practitioners often goes unacknowledged by the government.

“Information on this issue is mostly not available and the Ministry of Health has always officially denied that there are such large numbers of Cambodians and high-ranking officials seeking treatment abroad in Vietnam, Thailand or Singapore,” he says, adding, “Politically, the Cambodian government could not accept that fact.”

The chief issue, he says, is similar in public attitude to the second-hand car market – people see more choice, quality and affordability in used cars from abroad than they do at showrooms in Cambodia.

He goes on to compare this with the medical equipment and pharmaceutical industry.

The development, he argues, is hampered by poor logistics and taxation, as well as undefined laws and regulations in healthcare trading.

“Despite a lot of healthcare development from government and NGOs around the world, the basic healthcare in Cambodia could have some of the lowest quality in Southeast Asia. Cambodians do not trust their own system and the quality of services from local health care professionals and institutes because they have experienced better quality healthcare from neighbouring countries, which is naturally accessible and affordable.

“With better livelihoods, Cambodians are enjoying shopping for medical services from neighbouring counties which is readily accessible,” he explains.

A slow recovery

Responding to this, a spokesman for the Ministry of Health, Dr Ly Sovann, claims not to have any official figures on Cambodian medical tourists, but says: “It’s about 1 percent according to the World Bank. In 2015 it was just 1 percent of Cambodians finding treatment in Thailand, Vietnam, Singapore and France.

“Now, because the quality of service delivered in big hospitals in Cambodia – both in public and private facilities – has improved over the last three to four years, the Ministry of Health has tried to develop regulation to evaluate the quality of service delivered for the future.”

Despite the undeniable improvements that Cambodia’s healthcare system has made over the years, it doesn’t appear to be able to shake off its image problem as more Southeast Asian hospitals are offering Khmer translators and signs, according to Sivlin Cchay, the president of the Cambodia Association of Travel Agents.

“There is a significant number of Cambodians travelling abroad for medical purposes and Singapore, Thailand and Vietnam are not the only destinations for this purpose. It is unfortunate that we do not have the estimated figures.”

As with everyone else contacted, Cchay concedes that estimating the value of the industry, the average spend of Cambodians holidaying in hospitals abroad or even an accurate volume of medical tourists leaving the country is impossible to know, but almost all signs point to a growing predilection for being treated outside the Kingdom.

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