Health system in need of reform
Thailand’s healthcare system is in need of reform to ensure its sustainability. In the past month, medical care became a social debate after a series of incidents exposing the weaknesses in Thailand’s health system. From the financial crisis at state hospitals, the employment of professional nurses to the death of two young doctors in provincial hospitals, these issues exposed the weakness in the system. Although free medical access to all is a good principle, the system needs to be improved to ensure its effective continuity.
Most Thais currently receive medical care under the universal coverage scheme in which patients seek treatment free of charge from state hospitals.
In recent years, however, several hospitals have started to struggle financially because they have to service more patients in spite of their limited resources.
The number of medical personnel has not risen in line with the number of patients. Many medical professionals are facing a heavy workload amid a poor working environment. One of them was Thapakorn Thongkua, a 30-year-old physician attached to a hospital in Buri Ram, who died on May 14 after contracting dengue fever at the hospital.
If the problem of understaffing is not fixed, it will lead to a brain drain as more medical personnel leave for the better resources and pay on offer at private hospitals.
Last month the Federation of Physicians and Nurses released a table showing 18 state hospitals were suffering serious financial problems.
For instance, Pranangklao Hospital suffered a deficit of 355 million baht, Saraburi Hospital was 322 million baht in the red and Uttaradit Hospital suffered a deficit to the tune of 277 million baht.
State hospitals get income from three sources: the state budget; operators of three healthcare schemes, namely the universal coverage scheme, civil servants’ scheme and the social security scheme; and money received by hospital operators from sources such as donations. Contributions from the universal coverage scheme account for the largest portion of individual state hospitals’ income.
The concept of free medical service for all is theoretically perfect. However, the financial losses at state hospitals raise the question of whether solvent patients should pay for services to help hospitals stay financially afloat and be able to help needy patients.
Options have been raised such as a co-payment system to have solvent patients cover their medical costs if they can afford to dos so. The alternative is that only private hospitals will manage to earn income from patients who are able and willing to pay.
Financial losses at state hospitals raise the question of whether solvent patients should pay for services to help hospitals stay afloat
Poor people will eventually suffer because they would not get good basic health services from the government according to the laudable principle of universal health care.
Besides, there is a question about whether hospital administration should become more decentralised by giving more autonomy to rural hospitals to decide how to spend their money instead of following top-down instructions from the National Health Security Office (NHSO).
At present, the NHSO oversees budget distribution for Thailand’s 172-billion-baht annual healthcare system. Some of its decisions may not best suit individual health centres in rural areas. For instance, the NHSO fixes the same cost for serious illnesses such as heart disease even though each hospital may have different costs of treatment for the same illness.
Some state hospitals in the rural area argue that certain medical protocol details required by the NHSO are not practical in their communities, such as the protocol to treat patients undergoing dialysis for which the hospital will receive 20,000 baht per head.
The agency also acts as a broker for hospitals nationwide in procurement. The NHSO may argue that they could procure supplies more cheaply with a large order. In reality, some state hospitals would prefer to have more say in their own medical supplies.
Meanwhile, the success of each health centre should not simply be judged by the number of patients seeking medical services. Hospitals or their units in different areas should be encouraged to take part in illness prevention and protection.
This would not be possible without the decentralisation of hospital administration. Top-down administration tends to consider the numbers in its decisions rather than the nature of the surrounding culture and communities, which is a key element in ensuring dignity for users of medical services.
Communities should be engaged in decisions that affect their health because their participation would help promote the efficiency of medical services rather than relying on top-down decisions that tend to focus on financial aspects to the detriment of other factors.