Friday, February 15, 2013
Thailand - Medical fees rise as brain drain shrinks
More doctors needed in state hospital system
Ammar Siamwalla, a scholar at the Thailand Development Research Institute (TDRI), believes the government's plan to increase medical services fees will stem the ongoing brain drain from state hospitals to private institutions
Mr Ammar said the fee hike will attract medical staff, especially doctors, with state hospitals currently facing a shortage of physicians. However, he warned the policy must be implemented with care.
"I agree in principle with the hike on medical services fees but the government must flesh out the policy more to make it work effectively," Mr Ammar said.
The Foundation for Consumers (FFC) earlier slammed the ministry's plan to increase medical treatment fees by 5-10% on average at every state hospital, saying it could create chaos in the healthcare system.
The FFC warned the hike may encourage private hospitals to boost their fees in line with the increase at public hospitals, which could result in higher health insurance premiums.
The higher fees will take effect soon for patients who are not covered by the country's three health schemes _ the 30-baht universal healthcare scheme, the social security fund and the state officials' scheme.
About 99% of Thais are members of one of these three health schemes.
Mr Ammar is worried about the government's plan to turn Thailand into an international medical services hub. He said this would drive physicians away from state hospitals.
Private hospitals catering to medical tourists have lured many skilled physicians and specialists away from public and university hospitals. That will reduce the quality of service at state hospitals for the majority of Thais, he said.
He said TDRI research in 2008 on the impact of medical tourism found that it had the effect of raising medical services fees in Thailand to cover physicians' incomes.
TDRI said the Public Health Ministry doubled physicians' salaries in all community hospitals in 2008.
The research was published in the World Health Organisation's online bulletin in 2011.
Mr Ammar said that the government's policy of promoting medical tourism had caused physicians' incomes to rise.
"The government's continuing support for medical tourism will result in physicians' incomes rising even further," he said.
He said it was not yet certain if the fee hike would encourage operators of private hospitals to follow suit by raising their own rates.
He also said the public health system does not have a regulator ensuring that fees are maintained at a reasonable rate. This lack of regulation has resulted in a large gap in the quality of healthcare available between the rich and poor.
Dr Thaworn Sakunphanit, deputy director of the Health Insurance System Research Office, said medical labour costs in state hospitals have soared in the past four years.
Medical labour costs in state hospitals have increased by about 6% each year, he said, although medical technology costs have fallen as technology has become more accessible.
Salaries at state hospitals have been increased at more frequent intervals than at private hospitals to catch up with the higher pay on offer at the private institutions, Dr Thaworn said. Medical staff are attracted to private hospitals because of the higher pay.
The government is under pressure to increase pay further to retain medical staff at state hospitals, he said. This has become a major cost for the healthcare system.