Highlight: the regulation of healthcare suppliers and professionals in Cambodia
The licensing of healthcare providers and professionals
The Department of Hospital Services of the MOH is responsible for approving the establishment of medical institutions in Cambodia.
The Department of Drugs, Food, Medical Devices and Cosmetics under the MOH is the main regulatory body for pharmaceuticals in Cambodia. It is responsible for protecting public health by preparing and executing national policies and legal regulations on pharmaceuticals, traditional medicines, health supplement drugs and products, food, medical devices and cosmetics.39
ii Institutional healthcare providers and healthcare professionalsInstitutional healthcare providers
Institutional healthcare providers in Cambodia are public and private hospitals, clinics, polyclinics and consultation rooms (also known as cabinets).
As at December 2019, public health facilities comprised 1,221 health centres, 127 health posts, nine national hospitals, 25 municipal or provincial referral hospitals and 92 operational district referral hospitals.40
As at 31 December 2019, there were 14,432 private health facilities (compared with 12,785 in 2018),41 including 13,763 consultation rooms and 669 clinics, polyclinics and hospitals.42
Establishment of medical institutions
Medical practice may only be performed in Cambodia in medical institutions that are categorized as hospitals (having more than 80 beds for inpatients), polyclinics (having between 20 and 80 beds for inpatients), clinics (having between 10 and 20 beds for inpatients), and consultation rooms or cabinets (for outpatient consultation only).43
Prakas (ministerial order) No. 034 dated 4 July 2011 on the Modification of Procedures and Technical Conditions of the Request to Open, Close, Transform or Relocate Medical, Paramedical and Medical Aid Services sets out the permit requirements for the above-mentioned medical institutions.
Penalties for medical institution violations
Monitoring is carried out to ensure compliance with the conditions for the opening of establishments for the manufacture of pharmaceutical products. In the event of non-compliance with the conditions, penalties are applied.
The main legislation regulating pharmaceuticals in Cambodia is the Law on the Management of Pharmaceuticals (17 June 1996) (Pharmaceutical Law), as amended by the Law on the Amendment of the Law on the Management of Pharmaceuticals (28 December 2007), with other relevant ministerial regulations and notifications. The MOH has the authority to instruct on and control any activities relating to pharmaceuticals, and may appoint health agents to conduct monitoring at a pharmaceutical establishment (Pharmaceutical Law, Article 9). Any person who fails to obtain an authorization when opening, closing or relocating any pharmaceutical manufacturing establishment is subject to a fine ranging from US$2,500 to US$5,000. The MOH takes any violations that cause serious damage to public health or human and animal lives to court. Any person who obstructs the implementation of the Pharmaceutical Law is subject to imprisonment for between one and six months or a fine ranging from US$500 to US$2,500, or both.44 The applicant must first register the foreign manufacturer to register and import any medicinal products that are manufactured overseas. This process is subject to a different registration regime.45
Likewise, in cases of non-compliance with the permit requirements for establishing a medical institution, the Law on Management of Private Medical, Paramedical, and Medical Aid Profession, promulgated by Royal Kram No. NS/RKM/1100/10 dated 3 November 2000, imposes a fine ranging from US$250 to US$1,250, suspension of the medical institution’s operations from one to three months, or both. Any case of recidivism is subject to a double fine and suspension or termination of the operation.46
Healthcare providers and professionals are governed by several regulations, including the Law on Management of Private Medical, Paramedical and Medical Aid Profession mentioned above. In addition, there are five professional councils, namely the Medical Council of Cambodia,47 the Pharmaceutical Council of Cambodia, the Dental Council of Cambodia,48 the Cambodian Council of Nurses49 and the Cambodian Midwives Council.50 These councils assist the MOH in supervising and monitoring the practice of health professionals.
In accordance with the Law on Management of Private Medical, Paramedical and Medical Aid Profession, medical professionals and paramedical professionals refer to physicians, pharmacists, dentists and midwives, whereas medical aid professionals are nurses, laboratory specialists, physical therapists, dental specialists and similar professional practitioners.
To be entitled to practice as a medical, paramedical or medical aid professional, some common requirements are set out in the Law on Management of Private Medical, Paramedical and Medical Aid Profession, such as:
- being a Cambodian national;
- holding a diploma accredited by the MOH;
- being registered with the medical council, pharmacist council, dentist council, midwife council or nursing council;
- never having been convicted of any crime; other
- being physically fit to practice.
In addition, the Law on Regulation of Health Practitioners, dated 22 November 2016, further determines the rules and procedures for regulating health practitioners and the practice of their profession. The purpose of this law is to protect the health and safety of members of the public by providing the mechanisms for ensuring that all health practitioners are qualified, competent and fit to safely practice their profession. According to this Law, a health professional refers to a physician, dentist, midwife, nurse, pharmacist, laboratory specialist, physical therapist, dental specialist, radiologist or other health professional who is registered with the relevant health professional council. Article 6 of this Law sets out the access conditions for health professions. Any person who wishes to practice in the health profession shall be registered with a health professional council and hold a valid health practitioner licence. He or she must also maintain professional codes, standards and norms, and work within the scope of the practice of the health profession. A health practitioner may be considered unfit to practice by the health professional council if he or she:
- fails to meet the licensing requirements;
- is guilty of professional misconduct leading to the suspension or revocation of a health practitioner license;
- has a health condition (mental or physical) that impairs the person’s ability to practice; or
- has been convicted of a crime in Cambodia or any other country.
Disciplinary sanctions and complaints may occur if the health professional council has found a practitioner guilty of professional misconduct or to be unfit to practice. The following sanctions can be imposed:
- registrations in the personal file;
- temporary or permanent imposition of conditions on his or her practice;
- temporary suspension of the practitioner’s license or revocation of the license; or
- removal of the practitioner’s name from the register of the relevant health professional council.51
Foreign medical professionals, paramedical professionals and medical aid professionals are authorized to practice their profession in Cambodia in accordance with the procedures and conditions set out in Sub-Decree No. 094 on Procedure and Conditions Authorizing Foreign Medical, Paramedical and Medical Aid Professionals to Perform Private Professional Practices in the Kingdom of Cambodia dated 11 November 2002.
Criminal sentences for fraudulent practice of the medical professions may be found under Articles 639 to 644 of the Criminal Code, including any bribery of a member of a health professional council or doctor, or any person seeking to bribe a member of a health professional council or doctor doctor. In addition, any issuance of a false medical certificate or false medical statement engages the criminal liability of the authors.
There is no specific regulation governing liability in cases of medical malpractice or injury to the health of others. Therefore, such instances shall fall under the Civil Code of Cambodia.52 Normally, the relationship between a healthcare professional or institution and a patient is a contractual one. Hence, in the event of breach, malpractice or misconduct by a healthcare professional or institution, the latter’s liability may be engaged in accordance with Article 398 et seq. of the Civil Code.
There is no administrative court in Cambodia, meaning that a malpractice or misconduct case involving a public health professional or institution would also be treated by a civil court or criminal court, as the case may be.
Further, Cambodian laws and regulations do not impose any insurance requirements on health professionals. Consequently, not all health professionals subscribe to any liability insurance for their practice.
ii Notable cases
There is no publication of precedents, but court cases against clinics and doctors do exist in Cambodia.
Apart from possible professional malpractice or misconduct, certain cases concerning unethical behavior by health professionals have been disclosed in the press.
In a recent case, a doctor (a private practitioner) charged a farmer US$5,000 for treating his two children who had contracted dengue fever. This extortionate practice sparked public anger. This case highlighted the rise of certain dishonest practices by private practitioners in taking advantage of their profession by overbilling or misleading patients.
Another case in 2016 reinforced Cambodians’ loss of confidence in the healthcare provided by the country. In this case, a man suddenly died after receiving injections for back pain at a private clinic and the clinic subsequently closed.
These cases are rapidly publicized through social media. This is significantly shaping the popular perception of national health facilities in the country in an extremely negative way. Cambodians appear to be gradually losing confidence in their healthcare services, which directly increases the demand for and use of healthcare services abroad.53