Health Systems in Transition Vol. 5 No. 2 2015 The Kingdom of Cambodia Health System Review Written by: Peter Leslie Annear, Nossal Institute for Global Health, Australia John Grundy, Consultant, Cambodia and Australia Por Ir, National Institute of Public Health, Cambodia Bart Jacobs, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Chean Men, University Research Company, Cambodia Matthias Nachtnebel, Nossal Institute for Global Health, Australia Sophal Oum, University of Health Sciences, Cambodia Ann Robins, World Health Organization, Cambodia Chhun Eang Ros, Ministry of Health, Cambodia Edited by: Peter Leslie Annear, Nossal Institute for Global Health, University of Melbourne, Australia Co-Editors: Bart Jacobs, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Matthias Nachtnebel, Nossal Institute for Global Health, University of Melbourne, Australia Asia Pacific Observatory on Public Health Systems and Policies i WHO Library Cataloguing in Publication Data The Kingdom of Cambodia health system review (Health Systems in Transition, Vol. 5 No. 2 2015) 1. Delivery of healthcare. 2. Health transition. 3. Healthcare financing. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 691 7 (NLM Classification: WA 546 JC2) © World Health Organization 2015 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). 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The named authors alone are responsible for the views expressed in this publication. ii Contents Preface ................................................................................................................ viii Acknowledgements ............................................................................................. x List of abbreviations .......................................................................................... xii Abstract .............................................................................................................. xvii Executive Summary .......................................................................................... xix Health system context........................................................................................xix Organization and governance ...........................................................................xxi Health financing .................................................................................................xxii Physical and human resources ......................................................................xxiv Provision of care .................................................................................................xxv Major health reforms ......................................................................................xxvii Health system performance ............................................................................xxx Challenges for the future ................................................................................xxxi 1 Introduction ................................................................................................. 1 Chapter summary ................................................................................................. 1 1.1 Geography and sociodemography ............................................................ 1 1.2 Economic context ........................................................................................ 5 1.3 Political context ........................................................................................... 7 1.4 Health status .............................................................................................. 10 2 Organization and Governance ................................................................ 20 Chapter summary ............................................................................................... 20 2.1 Overview of the health system ................................................................ 20 2.2 Organization ............................................................................................... 21 2.3 Historical background .............................................................................. 24 2.4 Decentralization and deconcentration ................................................... 26 2.5 Planning ...................................................................................................... 30 2.6 Intersectoral cooperation......................................................................... 33 2.7 Health information management ........................................................... 34 2.8 Regulation ................................................................................................... 38 2.9 Patient empowerment .............................................................................. 41 iii 3 Financing .................................................................................................... 45 Chapter summary ............................................................................................... 45 3.1 Health expenditure .................................................................................... 46 3.2 Sources of revenue and financial flows ................................................. 48 3.3 Overview of the national health financing system ............................... 52 3.4 Out-of-pocket payments .......................................................................... 67 3.5 Voluntary health insurance ...................................................................... 71 3.6 Parallel health systems ............................................................................ 73 3.7 Payment mechanisms .............................................................................. 73 4 Physical and Human Resources ............................................................ 77 Chapter summary ............................................................................................... 77 4.1 Physical resources .................................................................................... 77 4.2 Human resources ...................................................................................... 85 5 Provision of services ................................................................................ 99 Chapter summary ............................................................................................... 99 5.1 Public health .............................................................................................. 99 5.2 Patient pathways ..................................................................................... 107 5.3 Primary ambulatory care ....................................................................... 108 5.4 Specialized ambulatory care/inpatient care ....................................... 109 5.5 Emergency care ....................................................................................... 113 5.6 Pharmaceutical care ............................................................................... 114 5.7 Rehabilitation and long-term care ....................................................... 115 5.8 Oncology and palliative care .................................................................. 116 5.9 Mental health care .................................................................................. 116 5.10 Dental care ............................................................................................... 117 5.11 Complementary and alternative medicine