To remedy deficiencies in the country’s hospitals, the Ministry of Health has been slowly turning a handful of the capital’s top public hospitals into semi-autonomous institutions.
Among other perks, these new public administration enterprises, as they are called, get to cut through red tape, which according to hospital directors and Health Ministry officials slows down funding and makes it difficult for hospitals to appropriate money.
“If we become an autonomous hospital, we have the right to manage our income, we can improve internally,” said Chhour Y Meng, director of the National Pediatric Hospital, which is slated to go autonomous sometime this year. “If we improve our quality of service people who can pay will come,” he said.
In developing its plan, the Ministry of Health has taken a “rising tides” approach, insisting that autonomy will not spell doom for those people who cannot afford the privatized costs but will instead expose the very poor–who will still be eligible for free treatment–to a higher level of medical care.
“At Calmette [hospital], we have a building for the poor people. They get all the same treatment and they don’t pay. Their cost is paid for by other patients,” said Dr Heng Taykry, director of Calmette and secretary of state at the Ministry of Health who is overseeing the transition.
But some are wary. While Dr Taykry points to Calmette-which up until June was the country’s only semi-autonomous hospital–as an example of the system’s application. Critics call the same institution a dark harbinger.
In August, the NGO Social Action for Change ran a small case study on Calmette with an eye toward the government’s expansion of the Public Administration Enterprise program.
“So far, the clearest example of hospital operation under autonomy is the Calmette Hospital. The hospital says that it does not deny anyone health care, even if they have no money. However many people testified that those without money get poor care at Calmette, they have to wait many hours for care and they are usually taken to a building at the rear of the hospital rather than placed in normal wards,” the organization contended.
“The ministry claims there will be more accountability from the doctors and the director. Since they have more salary, it will assure their work is better,” said Chrek Sophea, who conducted last year’s study. “Our only concern is: Who will ensure that poor people can access the healthcare they demand?” he asked.
In a sub-decree signed last June on the transformation of Preah Kossamak Hospital into a PAE, the institution was tasked to: “Consult and treat patients without discrimination and with the same technical grade of care.”
Guaranteeing this equity while in a semi-autonomous state could prove difficult, some contend.
Sin Somuny, executive director of Medicam, explained that ultimately the success of the program hinges on oversight.
“To do it well requires a good governance system in place…. If the government hospital is going to be semi-autonomous, there is a question of how do you ensure the accessibility of care for the poor, the marginalized,” he said, adding that the only way the autonomous system can work is if the government expands health equity funds–the government- and donor-supported system that currently covers healthcare for the poor.
Regardless, he said, policy changes are necessary.
“We know that the public hospital is fighting its way for survival.”
(Additional reporting by Saing Soenthrith and Kim Chan)