https://ijhpm.com
Int J Health Policy Manag 2022, 11(8), 1425–1431

doi 10.34172/ijhpm.2021.44

Original Article
Regional Differences in Admission Rates of Emergency
Patients Who Visited a Private General Hospital in the
Capital City of Cambodia: A Three-Year Observational
Study
ID

ID

Yurie Kobashi1* , Sophathya Cheam2, Yoshifumi Hayashi3,4, Masaharu Tsubokura5 , Veyleang Ly1,
Chanmakara Noun1, Takehiro Kozuma1, Buntongyi Nit6, Manabu Okawada2
Abstract
Background: Regional disparity is an imperative component of health disparity. In particular, providing emergency carethat is equally available in rural areas is an essential part of reducing the urban–rural disparity. The objective of this study
was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine theirbackground characteristics that cause this decline.
Methods: To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private
hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception
patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness
severity. The patients’ addresses were classified into 4 areas based on distance from the capital.
Results: A total of 6167 patients who visited the emergency department at SJH between January 2017 and September
2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased
with the distance from the capital. The proportion of patients who finished consultation decreased with the distancefrom the capital (P < .01: Chi-square test). The results of the logistic regression analysis showed that the admission rate inrural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted
for age, time, and season.
Conclusion: The admission rate of emergency patients who visited a private general hospital in Cambodia’s capital city
increased with distance from the capital city. To improve regional disparity among emergency patients, further researchis necessary to identify the issues among emergency patients, especially those who are vulnerable.
Keywords: Health Disparity, Regional Disparity, Developing Country, Global Health, Emergency Care
Copyright: © 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/
by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Citation: Kobashi Y, Cheam S, Hayashi Y, et al. Regional differences in admission rates of emergency patients who
visited a private general hospital in the capital city of Cambodia: a three-year observational study. Int J Health Policy
Manag. 2022;11(8):1425–1431.  doi:10.34172/ijhpm.2021.44

Article History:
Received: 24 August 2020
Accepted: 14 April 2021
ePublished: 19 May 2021

*Correspondence to:Yurie Kobashi
Email: yurie-s@umin.ac.jp

Key Messages
Implications for policy makers•
Gender and age influenced the association between rural–urban residence and hospitalization rates among emergency patients in complex
ways. Policy-makers are required to take consideration into vulnerable residents for planning emergency care countermeasure.
•
To clarify the health disparity suffered by the socially vulnerable, the system has to be improved to accumulate patient information such as social
economic status, disease name, patient level factors, and severity of patients’ diseases at various hospital levels.
•
Further investigation of both private and public hospitals is required to determine the health disparities among rural emergency patients,
especially for vulnerable residents.
Implications for the public
Regional disparity is a major component of health disparity. In particular, providing emergency care that is equally available in rural areas is an
essential part of reducing urban–rural disparity. Moreover, the present study found a difference in the admission rates among emergency patientswith regards to region, and clarified the patient’s characteristics that are related to regional differences in the admission rates. Thus, it could be
implied that healthcare disparity might exist among emergency patients based on regional areas, especially among vulnerable residents.

Full list of authors’ affiliations is available at the end of the article.

Kobashi et al

Background
Health equity is crucial based on ethical considerations and in
the prevention of negative social and economic consequences
on a national scale.1 Health disparity is thought to emerge
from the weaknesses of the health systems and individual
factors as follows: race, sex, sexual identity, age, disability,
socioeconomic status, geographic location, environmental
barriers, and stigmatization.1,2 In particular, there is a difference
between urban and rural health statuses and outcomes, which
are usually expressed in terms of utilization, spending, andgeographic distribution of providers and services.3-5 Thus,
regional disparity is an important component of healthdisparity, and its reduction is a crucial public health issue.
Several initiatives have been undertaken to reduce theurban–rural disparity until the present time. In particular,
providing emergency care, which has a life-saving role forpatients with severe disease as a part of primary care, that isequally available in rural areas is an essential part of reducing
this disparity.6,7 In this context, hospitalization rates varied
widely in each area in previous studies in the United States.8,9Moreover, urban locations have been shown to have reduced
hospitalization rates.9 Furthermore, the gap between urban
and rural areas regarding the quality of available treatment is
expected to widen in the future, and a comprehensive strategy
that addresses the existing issues is needed to overcome
this gap.10 Even in developing countries, the importance of
emergency care is increasing with the shift of the disease
burden from communicable diseases to accidents, injuries,
and non-communicable diseases.7,10,11 Meanwhile, emergency
care is being neglected in low- and middle-income countries(LMICs), even though approximately half of the preventable
deaths in these countries can be reduced by applying the basic
principles of emergency care.12,13 In response, global healthagencies have foregone the development of emergency systems
in favor of primary care to provide care for a larger numberof people in LMICs.14 Thus, it is vital to identify urban–ruraldisparities in emergency care as a part of addressing therelated existing issues in developing countries. Nevertheless,little research has been conducted in this area.
Cambodia has been classified as an LMIC by the World
Bank. However, over the last 20 years, 16.3 million Cambodian
nationals have witnessed considerable improvements inpublic health, with the country achieving most of the healthrelated Millennium Development Goals by 2015.15 Yet,in 2012, the nation had only 1.4 health workers per 1000
people.16 More specifically, some 40% of physicians and 74%
of specialist physicians work in the capital city, Phnom Penh,17
whereas 80% of the population still reside in communes inrural areas, and 90% of the nation’s poor are rural dwellers.18
Besides, private hospitals and clinics, in particular, areconcentrated in urban areas; this means that the regional
inequity in health services remains a crucial problem,19
as illustrated by the fact that the infant mortality rate isapproximately three times higher in rural settings than it isin urban settings.20 In addition, the emergency department
in Cambodia is not recognized as a specialty by the Ministryof Health and does not have a formal training program for1426

specialists in the discipline.12 Furthermore, the referral systemfor emergency patients in Cambodia differs between urban
and rural areas. Emergency patients in the capital urban area
are mainly transported to public hospitals in the capital, or
private hospitals, if patients request it. Meanwhile, emergency
patients in rural areas are transported to provincial public
hospitals from clinics or health centers first. If patients cannot
get adequate treatment in provincial public hospitals, they aretransferred to a hospital in the capital. Therefore, Cambodia
is an advantageous area to investigate the widening of urban–
rural disparities in emergency departments in developing
countries with the goal of improving regional disparity.
The objective of this study was to examine the worsening
admission rate among Cambodian rural emergency patientsand determine the patient’s background characteristics that
affect it. The difference in admission rates in each residentialarea, as an indicator of medical severity, among emergency
patients in private general hospitals in the capital city of
Cambodia was investigated by each patient’s backgroundcharacteristics to clarify regional disparity.
Methods
This study used a retrospective observational design.
Healthcare Systems in Cambodia
Approximately 90% of residents in Cambodia are Khmer—themost popular ethnicity. Cambodia has a large area (181 035
km2), and transportation time to the capital differs basedon the region. Most public hospitals in the capital city havebeen designated as institution members in 119 emergency
systems; however, emergency department classification is not
assigned for each private hospital. Moreover, ambulances arewidely used as part of emergency patient transport systems.21
Nevertheless, many residents use their own cars to transport
emergency patients due to the cost and recognition issuesof ambulances.21 Moreover, Cambodia has both a regulated
public health sector and an unregulated private healthsector. While a referral system has been developed between
provincial hospitals and health centers in public hospitals,
there is less of a referral system between private hospitals.5
In addition, while public hospitals and health centers are
required to be positioned based on the district or numberof residents, private hospitals are concentrated in urban
areas. Thus, it is essential to investigate patients’ backgroundcharacteristics and admission rates for each area in general
hospitals in the capital city, that both urban and rural patients
visit, to understand the regional disparity.
Site Detail
The Sunrise Japan Hospital (SJH) is an international private
general hospital in Phnom Penh, the capital city in Cambodia
with 14 medical departments, 50 beds for inpatients, anintensive care unit, 2 operating rooms, and endovasculartreatment facilities. SJH, which opened in 2016, aims toprovide Japanese standard quality medical care in Cambodia.
The hospital has 213 multinational personnel, including
Cambodian and Japanese staff as well as staff from other

International Journal of Health Policy and Management, 2022, 11(8), 1425–1431

Kobashi et al

countries. More than 90% of the patients are local residents
who speak Khmer as their first language, and the patients’economic statuses mainly range from middle class to affluent.
The largest number of foreign patients are Japanese. SJH has a
24-hour emergency department where more than two doctors
are always available to see patients. The hospital has advanced
facilities, including an operating room with microsurgery
equipment, magnetic resonance imaging, intensive careunit, and endovascular treatment room; hence, SJH canaccommodate severe status patients. Further, emergency
patients can undergo emergency surgery and emergency
endovascular treatment if necessary. In addition, SJH engages
in social activity in rural areas and continually makes efforts
to advertise hospitals in rural areas. For these reasons, SJH is asuitable hospital to identify regional health disparities among
emergency patients in Cambodia.
DatasetTo investigate the characteristics of patients who visited SJH,
a major general private hospital in Phnom Penh, patient datafrom November 2016 to September 2019 were obtained fromthe electronic reception patient database. The patient data
included addresses, consultation classification, next planclassification, patients’ primary language, insurance status,
visiting date, and visiting time. Information on province wasobtained using the author’s manual work from individual
patient address records.
Data Definition
Patients of all ages who visited the emergency department
between November 2016 and September 2019 were includedin this study. The exclusion criteria were foreigners who
did not speak the local language as their first language. The
residential areas were divided into four areas: Area 1 included
Phnom Penh, which is the capital; Area 2 included Kandal
province, which surrounds the capital city; Area 3 includes
five provinces adjacent to Kandal province (Kampong
Chhnang, Kampong Speu, Takeo, Kampong Cham, Prey Veng
province); and Area 4 included all other provinces (Figure 1).
The distance from Phnom Penh is greater in the ascendingorder for Areas 2, 3, and 4. It is also worth noting that in the
country, a year is divided into two seasons: the rainy seasonfrom May to October and the dry season from November toApril.
Primary Outcome
The primary outcome was defined as the proportion ofadmission patients as an indicator of illness severity. Transfers
were included as part of the admission for statistical analysis
because most patients who needed transfers had severe statuses
and required hospitalization after transfer.22 The admission
rate was set as the primary outcome because the admission
rate of emergency patients has been surveyed in many
countries and regions. This means that the admission rate
might be a valid indicator of the severity of illness and that theresults’ comparison with other regions will be easy. Moreover,in our literature review, information on the admission rate

Figure 1. The Four Areas for Analysis Divided by Geographic Location andDistance From the Capital: Area 1 as Phnom Penh of the capital; Area 2 as
Kandal province, which surrounds the capital city; Area 3 included five provinces
adjacent to Kandal province, (Kampong Chhnang, Kampong Speu, Takeo,
Kampong Cham, Prey Veng province); and Area 4 included all other provinces.

of emergency patients in private hospitals in the capital of
Cambodia was not found. Thus, the primary outcome wasinvestigated using patient background characteristics such as
gender and age groups.
AnalysisFirst, the patients’ background characteristics were analyzed
descriptively, and chi-square test or Mann-Whitney U test
were performed to compare the results based on gender.
Next, the shift in the number of emergency patients in eacharea was determined. Then, the proportions of admission rateand consultation completion rate (next plan classification),
gender, visiting time, and season for each of the four areas
were descriptively analyzed. A chi-square test was performed
for each classification based on address area. In addition, alogistic regression analysis was performed for univariate andmultivariate analyses. A univariate analysis was performed
to determine whether age, sex, address area, time, andseason affect the admission rate for emergency patients. The
multivariate logistic regression model was constructed withage, gender, address area, time, and season as independent
variables and the admission rate as the dependent variable.
The effect of address area on admission rate after adjusting
the age, gender, time, and season variables was determined.
Further, the effect of address area on admission rate after
adjusting the age, gender, time, and season variables wasdetermined by each gender group and age group with thesame multivariate logistic regression model. To compensate
for missing information in terms of address area, anothermultivariate logistic regression model—which added themissing values to the area variable as one of the components—
was constructed. The results using the multivariate logistic
models with and without missing values were almost the same
(Table S1, Supplementary file 1). Adjusted R2, goodness of fitof the models, was 0.104 for the model with missing values
and 0.134 for the model without missing values (Table S1).
Based on these results, it was assumed that the deficiencies
occurred randomly and that the presence of bias associatedInternational Journal of Health Policy and Management, 2022, 11(8), 1425–1431

1427

Kobashi et alwith deficiencies was small.
A statistically significant P value was set at .05. STATA IC(Lightstone, Texas, USA, version 15) was used for the analysis.
All methods were carried out in accordance with the STROBE
guidelines.
Results
A total of 6167 patients who visited the emergency
department at SJH between January 2017 and September
2019 were included in the analysis. Patient characteristics
are shown in Table 1. There was a higher percentage of males(51.97%) in the group. The median age (25th, 75th centiles)
was 59 [36, 73]. The most common next plan classification
was completion of consultations (44.97%). Only 0.62% of theparticipants used insurance.
Patients characteristics by gender groups are summarizedin Table S2. The proportion of patients who needed to behospitalized or transferred was higher in male than female
groups (P < .01: chi-square test). Out of pocket payment was
Table 1. Participant’s Characteristics (N = 6167)

No. (%)
GenderMale

3205 (51.97)

Female2962 (48.03)

Age (Median, [interquartile range])59 [36–73]

Address
Area 1 (Phnom Penh)

1428 (23.16)

Area 2 (Kandal)

147 (2.38)

Area 3 (Close to Kandal)

333 (5.40)

Area 4 (Other province)

320 (5.19)

Unknown

3939 (63.87)

InsuranceYes

38 (0.62)

No6129 (99.38)

Next plan classification
Completed consultation

2773 (44.97)

Revisit for medicine

81 (1.31)

Revisit for consultation

1078 (17.48)

Admission

1157 (18.76)

Transfer

67 (1.09)

Unknown

1011 (16.39)

Time
0:00-7:59

924 (14.98)

8:00-11:50

883 (14.32)

12:00-17:59

1709 (27.71)

18:00-23:59

2651 (42.99)

SeasonRainy season

3495 (56.67)

Dry season

2672 (43.33)

Out of Pocket Payment(Median, [interquartile range])1428

217.76 [100.62–358.06]

also higher in males than females (P < .01: Mann-Whitney Utest).
Figure 2 shows the monthly number of emergency patients
based on the address area. The number of patients increased
over the three years. The proportion of patients comingfrom Areas to 2–4 increased gradually during the first eightmonths; however, the proportion became constant after that
period. The proportion of patients coming from outside ofPhnom Penh was 94.92% from November to December 2016,
75.00% from January to June in 2017, and was maintained at
approximately 55% after that period.
Table 2 shows the proportion of patients based on area,
including admission rate of emergency patients, gender, age,
visiting time, and season. The proportion of patients whoneeded to be hospitalized or transferred was increased withthe distance from Phnom Penh. Meanwhile, the proportionof patients who finished their consultations decreased withthe distance from Phnom Penh (P < .01: chi-square test). The
most common visiting time for patients living in Area 1 was
18:00–23:59, whereas the most common visiting time forpatients living in Area 4 was 12:00–17:59.
The result of the univariate and the multivariate analyses
for whole group is shown in Table S3. The results of themultivariate analyses adjusted for gender, age, time, andseason showed that the admission rates of address areas 3 and
4 was significantly increased as compared to the admission
rates of address area 1.
Table 3 shows the results of the logistic regression analysis
by gender to determine whether the address area affects theadmission rate. The results of multivariate analyses adjusted
for age, time, and season showed that the admission rates ofaddress areas 3 and 4 was significantly increased as comparedto the admission rates of address area 1 only among males.
Table 4 shows the results of the logistic regression analysis
to determine whether the address area affects the admission
rate by age group. The results of multivariate analyses adjusted
for gender, time, and season showed that the admission rates
of address areas 2, 3 and 4 was significantly increased ascompared to the admission rates of address area 1; the result
was positively significant among the 20–59-year-old age
group, whereas it was negatively significant among the over59-years-old age group.
Discussion
It is a crucial public health issue to identify urban and ruraldisparities in the emergency department to reduce healthcare
disparities. This study aimed to determine whether theadmission rate is worsening among Cambodian rural
emergency patients and determine patients’ backgroundcharacteristics that affect it.
Moreover, gender and age influenced the association
between rural-urban residence and hospitalization rates incomplex ways. The association between address of residence
and hospitalization rate was greater among males and younger
patients. Considering that there was no significant differencein the number of patients by gender groups, female patientsInternational Journal of Health Policy and Management, 2022, 11(8), 1425–1431

Kobashi et al

Figure 2. The Number of Emergency Department Patients in Each Geographic Area Group Every Month.

from rural areas might have minor illnesses that did not require
hospitalization; or female patients from rural areas might havechosen outpatient treatment or consultation because they
had financial or other problems. The same assumption could
be made regarding age groups as well. To clarify the healthdisparities suffered by the socially vulnerable, improving thesystem to accumulate patient information such as economic
status and disease name is required at various hospital levels.
It was found that the proportion of the admission rate,
which might be associated with disease severity, increased
with distance from the capital. The logistic regression analysis
results for all participants showed that the hospitalization ratein the farthest address area from the capital was 2.1 times

that of the capital. The fact that out-of-pocket payments
increased with the distance from the capital did not conflictwith the results. A study on the admission rate of emergency
patients receiving Medicare across the United States in 2016
showed that the admission rate varied widely based on region,
sometimes even doubling; however, the cause of this disparity
has not been clarified.8 Besides, the previous study showedthat racial differences affected the admission rates for heart
failure,23 and that being young males from deprived areas
affected emergency hospital admission rate for violence.24
Based on the fact that the present study showed a differencein admission rate by region as well, and the fact that the
emergency transport systems of the rural areas are fragile,21

Table 2. Proportion of Admission Rate of Emergency Patients by Gender, Age, Time, Season, and Address Area

Area 1

Area 2

Area 3

Area 4Male

776 (54.34)

82 (55.78)

170 (51.05)

169 (52.81)

Female652 (45.66)

65 (44.22)

163 (48.95)

151 (47.19)

56 [33–73]

66 [52–73]

65 [46–73]

61 [52–74]

Consultation completion

695 (56.18)

71 (55.47)

115 (40.93)

106 (40.15)

Revisit282 (22.80)

26 (20.31)

71 (25.27)

59 (22.35)

Admission, transfer

260 (21.02)

31 (24.22)

95 (33.81)

99(37.50)

0:00-7:59

222 (15.55)

16 (10.88)

46 (13.81)

47 (14.69)

8:00-11:50

168 (11.76)

24 (16.33)

62 (18.62)

39 (12.19)

12:00-17:59

396 (27.73)

36 (24.49)

98 (29.43)

118 (36.88)

18:00-23:59

642 (44.96)

71 (48.30)

127 (38.14)

116 (36.25)

Rainy season

807 (56.51)

87 (59.18)

189 (56.76)

204 (63.75)

Dry season

621 (43.49)

60 (40.82)

144 (43.24)

116 (36.25)

209.65[103.47-103.47]

276.53[129.00-416.29]

287.95[157.10-392.69]

309.80[178.66-430.71]

GenderAge (Median, [interquartile range])
Next classification

Time

a

a

SeasonOut of Pocket Payment (Median, [interquartile range])a

P < .01 with Chi-square test.

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Kobashi et al
Table 3. Multivariate Logistic Regression Analysis by Gender to Determine
Whether the Address Area Affects the Admission Rate

Table 4. Multivariate Logistic Regression Analysis by Age Groups to Determine
Whether the Address Area Affects to the Admission Rate

Multivariate Analysis, Adjusted OR (95% CI)

Multivariate Analysis, Adjusted OR (95% CI)

Male (n = 1.001)

Female (n = 909)

1.03 (1.02-1.04)a

1.04 (1.03-1.05)a

20-59 Years Old(n = 791)

Over 59 Years Old(n = 962)

Ref.

Ref.

Male

Ref.

Ref.

Kandal1.21 (0.70-2.09)

0.58 (0.26-1.30)

Female0.57 (0.38-0.85)

Close to Kandal

2.62 (1.72-3.99)a

1.11 (0.72-1.72)

Other

3.57 (2.36-5.40)

1.06 (0.66-1.71)

Age
Address
Phnom PenhaTime
8:00-11:50

Ref.

Ref.

12:00-17:59

2.83 (1.50-5.33)a

1.56 (0.82-2.95)

18:00-23:59

3.68 (1.96-6.91)a2.60 (1.44-4.70)a

0:00-7:59

3.43 (1.73-6.81)

3.18 (1.62-6.26)

aaSeasonRainy season

Ref.

Ref.

Dry season

1.01 (0.75-1.38)

0.84 (0.59-1.19)

Abbreviation: OR, odds ratio.
a
P < .01.

it can be inferred that the differences between regions might
affect the health statuses of emergency patients in rural areas.
Further research is thus required to determine the healthdisparities of emergency patients. This includes gathering
information on the diseases, ailments, conditions, and otherspecific details of individual cases.
Moreover, it was found that the number of emergency
patients visiting SJH has increased in the three-year period
being studied in both urban and rural areas. In Cambodia,
medical tourism in which patients visit neighboring countries
such as Thailand,25 Vietnam, and Singapore for moreadvanced medical care is becoming a trend. However, somepatients changed their minds and came to SJH instead ofgoing to hospitals abroad (data not shown). Moreover, due
to the COVID-19 pandemic, various barriers have appeared
to going to hospitals abroad; consequently, a system throughwhich patients can be transported for medical care to domestic
hospitals might be required, especially for emergency
departments and departments that have minimal time forlife-saving. Until the present time, the Ministry of Healthin Cambodia has taken measures to improve the patienttransportation system and raise awareness on emergency callsin the community. Four elements are required to improvethe emergency system in Cambodia as per previous reports:
access to transportation methods, triage, inter-institution
cooperation and communication, and pre-hospital care.21
Further, the emergency department can be a potential target
department for increasing the proportion of patients who
receive medical care in domestic hospitals.
The admission rate of patients who visited SJH was lower
than that of provincial public hospitals in rural areas. The
admission rate of patients who visited SJH was about 20%,
whereas the admission rate of patients who visited provincial
public hospitals (Battambang Provincial Hospital, Sampov
Meas Provincial Hospital) in rural areas was 60%.12 The
1430

Gendera0.58 (0.44-0.76)a

Ref.

Ref.

Kandal2.40 (1.16-4.95)b

0.55 (0.31-0.98)b

Close to Kandal

2.05 (1.13-3.71)b

1.55 (1.08-2.21)bOther

3.20 (1.95-5.25)

a1.64 (1.12-2.40)b

8:00-11:50

Ref.

Ref.

12:00-17:59

1.95 (0.92-4.14)

2.81 (1.58-4.99)a

18:00-23:59

2.54 (1.23-5.25)b

4.21 (2.40-7.38)a

0:00-7:59

2.37 (1.04-5.42)

b

3.34 (1.80-6.20)aRainy season

Ref.

Ref.

Dry season

0.59 (0.39-0.90)b

0.91 (0.68-1.21)

Address
Phnom Penh

Time

SeasonAbbreviation: OR, odds ratio.
a
P < .01, b P < .05,

proportion of admission rate at 60% was higher as compared tothe admission rate in developed countries.8,22 This difference
might be due to the following reasons: the SJH has substantial
facilities and equipment for diagnosis, which reduces the
proportion of hospitalized patients; medical costs in private
hospitals are expensive compared to public hospitals; and theseverity of patients’ conditions was mild as compared to thatin public hospitals. Nevertheless, further investigation on thecauses of this difference is required through the examinationof both private and public hospitals.
When interpreting these findings, several limitations should
be considered. First, consultation bias should be considered
because the present research is a single-facility study in a
private hospital. Second, many address data were not identified.
Since entering address information was left to the individual
patient, there was a large amount of incomplete information
with only street address data and/or erroneous data. Third,
obtaining the information on social status, underlying causesof the disparities, patient level factors, and severity of patients’diseases was insufficient. Previous studies have shown that
wealth inequality and inequality in healthcare access caused
health disparities, especially in developing countries.26 On theother hand, the use of electronic medical records and electric
databases is inadequate in Cambodia, and the standards forrecording primary patient information such as disease names
are vague; therefore, this information could not be sufficiently
obtained. A cohort study to investigate how these underlying
causes of the disparities affect the hospitalization rates might
be the most crucial further research. Fourth, the present study
could not obtain the data on length of stay, health outcomes,
complications, and mortality for comparison with the resident
addresses. Further study is required to examine the likelihoodof admission of rural people based on this information. Fifth,

International Journal of Health Policy and Management, 2022, 11(8), 1425–1431

Kobashi et alone of the most crucial limitations was that this study did notinclude information on causes of admissions. Despite theselimitations, the present study is the first to provide informationon the correlation between the address area and admission
rate of emergency patients in a private general hospital in thecapital to improve the regional disparity among emergency
patients in Cambodia.
Conclusion
The admission rate of emergency patients who visited aprivate general hospital in Cambodia’s capital city increased
with distance from the capital city, especially among males.
To improve regional disparity among emergency patients,
further research is required to identify the issues among rural
emergency patients especially those who are vulnerable.

6.
7.

8.

9.

10.

11.

12.

Acknowledgement
We would like to thank Mr. Kamata Keiya and Mr. Takahiro
Yoshimi and all staff members at the SJH, Phnom Penh forproviding critical data for this research.
Ethical issues

All experimental protocols in the present study were approved by the National
Ethics Committee for Health Research in Cambodia (Ethics Committee, ID:
079NECHR). Individual informed consent was waived by the National Ethics
Committee for Health Research in Cambodia, because the opt-out consent
process was used in this study.

Competing interests

13.

14.

15.

16.

Authors declare that they have no competing interests.

Authors’ contributions

All the authors made a substantial contribution to this research. YK, MT, and MO
contributed to the writing the paper, while all members contributed to the study
design, data collection, and coordination with local stakeholders.

Funding17.

This research did not receive any specific grant from any funding agency in the
public, commercial, or non-profit sector.

18.

Authors’ affiliations

19.

Department of General Internal Medicine, Sunrise Japan Hospital Phnom
Penh, Phnom Penh, Cambodia. 2Department of Pediatrics, Sunrise Japan
Hospital Phnom Penh, Phnom Penh, Cambodia. 3Department of Neurosurgery,
Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia. 4Departmentof Neurosurgery, Kitahara International Hospital, Tokyo, Japan. 5Department ofInternal Medicine, Soma Central Hospital, Fukushima, Japan. 6Department ofMedicine, University of Puthisastra, Phnom Penh, Cambodia.
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Supplementary files

Supplementary file 1 contains Tables S1-S3.

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