Healthcare Resource Guide: Cambodia

Updated November 2019

Cambodia Statistics

Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Reimbursement

Barriers

Procurement & Tenders

Trade Events

Government Links & Assoc.

FAQs

Statistics

CS Contact

Capital: Phnom Penh

Population: 16.5 Million

GDP: $26.8 Billion

Currency: Khmer Riels (KHR)

Language: Khmer

Summary

The Cambodian healthcare market is comprised of a wide variety of providers, including public health facilities, pharmacies, private hospitals, and professional medical service providers. The latter typically operate from their own facilities or travel directly to patients’ homes. Qualified private providers and pharmacies are mostly available in urban areas. Two-thirds of public health staff also work separately in some private capacity. In addition, a number of NGO-run health facilities and charitable hospitals provide services. As of June 2019, there were 2,803 registered pharmacies, 446 drug import/export companies and branches, and 19 medical manufacturing institutions in Cambodia. Apart from formal healthcare services, informal healthcare providers are common throughout Cambodia: these include vendors selling drugs from shops or markets and traditional birth attendants, as well as traditional healers.

In 2017, the Cambodian market spent about US $1.1 billion in general health care and US $296 million on pharmaceutical products.

The public sector plays a lead role in promotion and prevention activities for essential reproductive, maternal, neonatal and pediatric health, and major communicable diseases control. However, private practitioners remain popular for curative care. According to the 2014 Cambodian Demographic and Health Survey, only 21.9% of sick or injured patients sought care first at public sector facilities, while 67.1% did so from private health providers. Within the private sector, private pharmacies were most often visited for treatment in urban areas (60%), and private clinics were the most common source in rural areas (23.5%). Most high income and some middle-income people seek medical treatment abroad for complex or emergency cases, primarily in Vietnam, Thailand, and Singapore.

https://www.medbox.org/cambodia-demographic-and-health-survey-2014/download.pdf

The Cambodian government is increasing spending on healthcare. Government spending in the healthcare sector increased 16% for 2018 compared to 2017. The primary reason for this is the overall increase of the Cambodian government budget.

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Market Entry

Cambodia allows 100% foreign ownership of businesses, allowing market entrants the ability to set up their own companies locally. However, many U.S. companies have found it advantageous to work with partners (agents or distributors) who have strong local experience and networks as well as knowledge of the local market, rules, and regulations. A reputable local partner can be key to maintaining good relationships with local customers whose procurement decisions are influenced mostly by trust.

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Current Market Trends

The Ministry of Health is the single largest purchaser of drugs, medical supplies, and medical equipment in the country; however, the proportion of healthcare services provided by the private sector exceeds that of public institutions. These services range from consulting to treatment. Consistent with Cambodia’s rapidly growing economy and demand for medical services, a number of new private hospitals and clinics have opened throughout the country in the past few years, and more are expected in the future. These private hospitals are mostly built by private local and international doctors, as well as international franchises from Thailand, Vietnam, Singapore and Japan.

The dental market is gaining increased interest from medical tourists from developed countries such as Japan, Australia, and those in the Middle East. Approximately 20 dental clinics in Phnom Penh are operating in accordance with international standards, appropriate ISO certification, and western-trained staff.

There has been tremendous growth in the consumption of pharmaceutical products in Cambodia, with an annual growth rate averaging around 10%. Private pharmacies are first visited for treatment by 41% of ill and injured patients in urban areas. Local pharmaceutical importers are eager to import U.S.-made products, and Cambodian consumers are keen to receive what they perceive to be high-quality treatments offered by American medical products.

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Main Competitors

As is common in other markets, U.S. pharmaceuticals face competition in Cambodia from pharmaceuticals imported from lower-cost countries including Thailand, Indonesia, Malaysia, Pakistan, and India. Products from those countries are very competitive in targeting the lower end of the market.

The main competitors of U.S. medical device companies are from Japan and European countries, primarily Germany. Consumable healthcare products from China are also very popular in the market due to their competitive prices.

Companies from Australia, New Zealand, U.K, Germany, the Czech Republic, Poland, Korea, and Japan also market health supplements in Cambodia.

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Current Demand

Medical devices with significant sales potential in Cambodia include diagnostic devices and imaging equipment such as ultrasound machines, x-ray machines, and CT scanners. However, the challenge in this market is the high degree of competition from medical device companies from other countries in the region.

Maternal Care

The Cambodian government has made maternal health a priority in recent years, and now nearly 90 percent of births take place under the care of a skilled birth attendant. Cambodia’s young population, where the median age a woman first gives birth is 22, also contributes to the high demand for maternal care services. Unfortunately, the supply of high-quality maternal care is limited.

As incomes rise and insurance becomes more common, more people are willing to pay for safe and clean maternal facilities. With the limited supply, many high-income Cambodians travel to Thailand and Singapore to deliver babies. The main challenge in opening high-quality maternal care facilities in Cambodia is the lack of qualified personnel to fill the jobs.

Health Supplements

Over the last decade, the Cambodian population has become more knowledgeable about the importance of health care and health supplements, and nutrition products are becoming more popular as people are more commonly taking a preventive approach to their healthcare. The areas of greatest demand include Phnom Penh and the larger provincial towns in Cambodia.

From 2008 to 2018, there were 1,400 health supplements registered in the Cambodian market.

Two major U.S. supplement brands that are prominent in Cambodia are Unicity and Herbalife. One significant challenge that comes with selling supplements in Cambodia is parallel imports (U.S. products imported into Cambodia from neighboring countries such as Vietnam and Thailand) because many of those products evade taxes when they cross the border into Cambodia.

Health and Life Insurance

There is a rising demand for health insurance by Cambodia’s growing middle class. Poorer populations are increasingly targeted by government and NGO healthcare insurance, and wealthier Cambodians purchase policies from international insurance companies. The middle class, by contrast, has relatively few options for reliable insurance. About 60% of the total health expenditure in Cambodia is comprised of out-of-pocket payments.

The relative availability of options in health and life insurance in Cambodia remains very limited. With a growing middle class, there is increasing demand for quality insurance options. There are 13 general insurers and nine life insurance companies operating in the country. Between 2013 and 2018, the annual compound average growth rate was 15.7% for general insurance and 120.5% for life insurance. The challenge that comes with selling health insurance in Cambodia is the limited information about the population, which makes it hard to calculate the optimal premium. In addition, the insurance concept is still very new to the majority of the population. More information and education in the sector are a critical step in selling insurance in Cambodia.

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Registration Process

Imported medicines and medical products must be registered at the Ministry of Health for laboratory testing.

Medical devices are divided into four categories according to their levels of risk: low, fairly low, fairly high, and high. The minimum required documents for registration include an application form, GMP or ISO certificates, a free sale certificate, a letter of authorization, and the product’s manual. Registration of the latter three categories also requires registration certificates from the country of export, an analysis report from the manufacturer, and technical documents. The product registration process should normally take three to six months; however, it might take up to 10 months to one year depending on the Ministry of Health’s product registration workload. The registration certificate is valid for three years from the date of issuance. The company must re-apply for a new registration certificate six months before the expiration of the previous certificate. All imported pharmaceutical products are required to have at least 18 months validity before the expiry date.

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Reimbursement

There are no government controls or reimbursement systems for drugs in Cambodia.

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Barriers

There are no specific barriers for foreign firms to import medical products into Cambodia. Three types of pharmaceutical products are restricted in Cambodia: narcotic drugs, psychotropic substances, and precursors. Medical importers need to send their products to the Ministry of Health for testing to determine if they fall under any specific restrictions.

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Procurement & Tenders

http://www.medicaltenders.com/medical_tenders_cambodia.htm

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Trade Events

There is an annual health fair in Cambodia that takes place in September. The health fair involves companies that represent pharmaceutical products, medical equipment and devices, hospital services, and dental care. In 2019, the event will take place in Phnom Penh, the capital city of Cambodia, from September 17-18. –

Trade Event - Pharmed-Cambodia: https://www.pharmed-expo.com/cambodia-1.html

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Government Links and Associations

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FAQs

How long does registration of medical products take in Cambodia?

On average, products take between 6-12 months to be registered in Cambodia depending on their level of complexity, bureaucracies, and relationships. Most local companies are willing to assist with registering products once you partner with them. In addition, there are also agencies to deal with registrations as a fee-based service. For more information on local professional services, please go to: http://apps.export.gov/article?id=Cambodia-Local-Professional-Services

What are the rates of custom duties for medical products in Cambodia?

Various medical products have different custom duties ranging from 0-35%. More information can be found at http://www.customs.gov.kh/publication-and-resources/customs-tariff-of-cambodia-2017/

What is the practical market entry strategy you would recommend?

Working with a local partner, such as an agent or distributor, has been an effective way to reach Cambodian consumers for many market entrants. A local partner can facilitate and expedite market entry through market knowledge and established networks. In Cambodia, personal relationships can be the key to successful business transactions.

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Statistics Snapshot

Market Size

Healthcare spending (including investment)

 

... as percent of GDP

6% (2016)

Hospitals, Procedures, Healthcare Professionals UN:

Number of hospitals

 

…Public

33 National/Provincial Hospitals (2016)

…Private

54 (2016)

Number of hospital beds

 

... available beds per capita

0.85 (2018)

Number of surgical procedures

706 (2012)

Physicians

0.17/1000 population (2013)

Dentists

476 Dentists, Dental Assistants, and Dental Nurses (2016)

Demographics

Population

16,204,486 (July 2017 estimate)

Life expectancy men/women

62.4 years old/ 67.5 years old (2017 estimate)

Infant mortality

25 deaths/1,000 live births

Percent of population older than 65

4%

...projection, 2030

6%

Annual deaths

0.72% (2018)

…caused by Communicable, maternal, perinatal and nutritional conditions

37%

…caused by Cardiovascular diseases

24%

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U.S. Commercial Service Contact Information

Name: SOKKEA HOY

Position: Commercial Specialist

Email: HoyS@state.gov

Phone: +85599369091           

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