Two years ago, my mother was diagnosed with liver cancer. Doctors said the cancer was advanced and inoperable.
As with many cancer cases, my mother’s diagnosis came as a shock. Two months earlier, I had taken her to two well-known private hospitals in Phnom Penh after she had complained about loss of appetite, a thick layer of buildup coating her tongue, and extreme exhaustion. After tests and consultations, including a chest X-ray, doctors gave her antifungal medication and sent us home. They said they did not find any major concern. But her exhaustion persisted, and she was losing weight. We decided to take her to Bangkok, where a CT scan quickly found a large 8.4-centimeter tumor in her liver.
A missed diagnosis such as my mother’s case and other examples of medical errors are some of the reasons many Cambodians seek care in other countries. In 2023, a 22-year-old woman died from complications after her small intestine was mistakenly removed instead of her umbilical cord in a medical procedure performed at a private clinic in Kampong Speu province. Seeking healthcare services abroad has also been driven by Cambodia’s recent economic growth and the ease of regional travel through the ASEAN Framework Agreement on Visa Exemption.
Cambodians who go to another country for medical care come from a wide range of financial situations. A small number of wealthy individuals go to Singapore or other high-income countries for world-class care. Those who can afford less go to Thailand and Vietnam, and some poorer patients with serious diseases undertake long overland journeys to reach them. Many go into debt to pay for healthcare.
During my latest trip to assist with my mother’s cancer treatment in Bangkok, I spoke with a 62-year-old Cambodian man who stayed at a small hotel that my mother usually stays at. He has been going to Bangkok for back pain treatment and said that he trusted the Thai medical system more than Cambodia’s. Another woman at the hotel said she was waiting for test results of a lump in her neck and visiting an elderly aunt who was undergoing surgery. On any given day, two dozen Cambodians fill this hotel, where the staff has learned to speak Khmer and signs are written in Khmer. Some stay for up to a few weeks while receiving medical treatment.
Medical Tourism and the Cost of Care Abroad
There is no comprehensive data on how many Cambodians travel abroad for medical treatment or the amount they spend. A local paper reported that in 2023, between 200,000 and 250,000 Cambodians were estimated to have gone abroad for medical purposes. Another paper estimated that up to 30 percent of Cambodians who visited Thailand and Vietnam between 2015 and 2016 sought medical services. This aligns with what a Thai paper reported last year: that at one private hospital in Bangkok, 30 percent of its foreign patients were Cambodians, and that in the first seven months of 2024, Cambodian patients spent about $1.3 million on treatment at this particular hospital.
While seeking medical care abroad is a patient’s choice, many Cambodians with serious diseases do not feel that they have a reliable option for quality care at home. Many would prefer to access good quality and affordable treatments in their own country. Getting care abroad comes with a steep price and logistical complications. For example, at Ramathibodi Hospital, a teaching hospital in Thailand, an MRI scan for a non-Thai citizen costs approximately 26,000 THB (about $750). There are also costs of plane tickets, accommodation, food, ground transportation, and language interpretation services that all substantially increase total expenditures. The total costs for an MRI can easily approach $1,500 when including all the associated expenses. To put this in perspective, Cambodia’s annual GDP per capita was $1,917 in 2023.
The Changing Healthcare Landscape
With a growing aging population who are increasingly facing more expensive and challenging non-communicable diseases, costs of care are increasing. In 2019, people aged 60 or older represented 9 percent of Cambodia’s population, a 60 percent increase from 2008. This age segment will increase to 23 percent of Cambodia’s total population by 2050, according to the 2019 General Census of Cambodia. Non-communicable diseases, such as cardiovascular disease, cancer, chronic respiratory illness, and diabetes, are now leading causes of death and can “exacerbate poverty and threaten Cambodia’s other development goals,” according to the Ministry of Health.
Most families are largely unprepared. Virtually every Cambodian over the age of 50 is a survivor of the Khmer Rouge genocide. Most have no health insurance and social safety net; only 22 percent of women and 13 percent of men between the ages of 15 and 49 have health insurance, according to the 2021-2022 Cambodia Demographic and Health Survey. Most elderly have no savings and rely on their adult children to care for them. For example, a study of 50 randomly selected people aged 60 and older in Kampot and Takeo provinces found that 76 percent of the respondents reported having no income and depending entirely on their children or grandchildren to provide for them.
At a national level, an analysis of healthcare system efficiency and equity in ASEAN indicated that Cambodia scores the lowest for efficiency. When it comes to healthcare equity, Singapore, Brunei, and Malaysia have a high degree of equity in healthcare resource distribution, both geographically and demographically. Cambodia sits closer to Myanmar and Laos and is characterized by “inadequate access to medical resources and imbalances in their geographic and demographic distribution.”
Signs of Progress, but More Needs to Be Done
Over the years, the Cambodian government has worked to improve healthcare services and provide more social protections, including establishing the National Aging Policy 2017-2030 and the National Social Protection Policy Framework (2016-2025), among other efforts. Overall, Cambodia has two main social security schemes: the National Social Security Fund (NSSF) and the Health Equity Fund (HEF). The NSSF is a social insurance scheme for public and private sector employees. For example, private sector employers who have at least eight staff are required to contribute 2.6 percent of an employee’s gross wage to the NSSF, while the employee must pay an equivalent amount. The HEF improves access to healthcare among a pre-identified cohort of the poorest and most vulnerable populations (known as IDpoor holders) by paying for health services delivered by public health facilities to the eligible population.
But implementing these policies still faces challenges. The NSSF has expanded coverage, yet the majority of the population (70 percent) still has no access to social health protection, according to the International Labor Organization (ILO). The government figure places that rate slightly higher, claiming that 41 percent of the population is covered. In addition, an ILO review of the NSSF operations found that many departments and functions perform similar tasks and operate in silos. The review further added that the monitoring and evaluation function is “severely limited” by the lack of statistical capacity. Similarly, the implementation of the first phase of the NAP 2017-2030 saw slow progress in supporting the elderly population due to a lack of public awareness about the policy and lack of implementing budget, according to a study.
Thailand offers Cambodia an example to look at close to home. In 2002, Thailand launched universal health coverage to provide health services to its then roughly 64 million population. The coverage is funded through tax revenues. Thai citizens are now entitled to preventive, curative, and palliative health services. Coverage has been expanded to cover more expensive treatments such as diabetes and cancer treatment. Since the launch, Thailand has seen great benefits: life expectancy has risen and formerly uninsured households are saving more, while the infant mortality rate, out-of-pocket spending, and incidents of catastrophic healthcare spending have decreased.
Social and cultural expectations dictate that Cambodian children must care for their aging parents. But many adult children often lack the financial capability and healthcare coverage for themselves. As more Cambodians grow older and face more challenging non-communicable illnesses, caring for them is no longer just a family matter. It is a national economic and social matter. Cambodians and the Cambodian economy will benefit from being able to access advanced medical care at affordable costs at home.