Hospitals close to collapse: Thai official

[Cadbury]

21 minutes ago, robblok said:

Do you have an education in finance / accounting.. if so ask for a refund. You should have read what i posted instead of denying it. I said the budget was higher both in actual number as in a percentage of the budget. The latter is the most important, do read again so the budget was higher as a percentage too. That was why i mentioned it otherwise you would be right.

 

You with your number one badge for lack of reading skills should try to read slower. You would have been right if the actual percentage of budget allocation had not gone up to. But no you failed in reading.

 

Why would i defend Prayut, the guy is an idiot.. i am just attacking your statement with facts about the health budget. 9,6% and 9,3% (pre junta) vs 10,1 and 10,4%.. clearly an increase in budget.

 

Its not as much defending the junta as just not liking false information. Had it been different I would have posted it too. 

I didn't originally quote any statistics in my comments about health and hospitals. If you want to carry on a debate with yourself about statistics and percentages while ignoring the moral and ethical principles that I was referring to then I'll leave you to it. 

[cmrichsw]

1 minute ago, Orton Rd said:

 

How much of the increased budget actually reached Hospitals and Doctors? there are no fancy charts to show how much gets stolen!

NOOO you must be joking 55555++

[robblok]

5 minutes ago, Cadbury said:

I didn't originally quote any statistics in my comments about health and hospitals. If you want to carry on a debate with yourself about statistics and percentages while ignoring the moral and ethical principles that I was referring to then I'll leave you to it. 

Ah deflections how nice.

 

You mean originally you did not include facts in your statement.. just a moan based on your feelings.. then i came with facts and you were not happy.

 

Fact is the junta spend a higher percentage of the budget for healthcare then the previous governments so how you can say they are worse is beyond me. They if anything do more because of the increased budget. This problem has been a long time in the making ever since Thaksin started free healthcare (a great plan) but did not fund it and neither did successive governments. 

 

So now the problems of the past come out and you blame the people who actually spend MORE percentage wise and in an amount too then democratic governments just because you don't like the junta.

 

I dislike them too, but i prefer facts..and how much money is pumped is is a fact. 

 

 

Edited October 4, 2018 by robblok

[robblok]

6 minutes ago, Orton Rd said:

 

How much of the increased budget actually reached Hospitals and Doctors? there are no fancy charts to show how much gets stolen!

And before nothing got stolen ? your logic is failing. 

[Orton Rd]

Just now, robblok said:

And before nothing got stolen ? your logic is failing. 

 

It has nothing to do with logic but corruption and greed. Figures on a chart and accounts mean nothing here, only the naïve are impressed. 

[Ossy]

2 hours ago, Samui Bodoh said:

if they were 'Good' people, they'd have money.  

I can hardly believe you said that, SB. Do you believe that the poor and poverty-stricken, out in the sticks, i.e. the rice-lands, of many northern and north-eastern provinces, cannot be 'Good' people, because of the poverty trap within which they live. For such a bold statement, you ought to have a remedy up your sleeve, by which the poor can get themselves into the money . . . well, have you?

[MaxYakov]

1 hour ago, wwest5829 said:

By all or by some?

 

Pessimistic or optimistic?

[Samui Bodoh]

14 minutes ago, Ossy said:

I can hardly believe you said that, SB. Do you believe that the poor and poverty-stricken, out in the sticks, i.e. the rice-lands, of many northern and north-eastern provinces, cannot be 'Good' people, because of the poverty trap within which they live. For such a bold statement, you ought to have a remedy up your sleeve, by which the poor can get themselves into the money . . . well, have you?

Hi Ossy

 

I was being sarcastic.

 

I should know better; sarcasm often does not work on this Forum.

 

Rest assured, I am very much in solidarity with the poor and against those who believe that the poor should be forced to die in the street.

 

In a civilized society, health care is a right, not a privilege.

 

 

[lanista]

Its amazing this country still functions at all when you consider that 30% of the annual budget disappears into corrupt pockets, insane submarine and aircraft carrier purchases and millions of low income  Thais dont pay tax.

Alot of school classrooms  havent had new desks in decades yet the education budget is supposed to be the biggest in the government.

Has THAI Airways ever made a profit?

All the money has gone .

Edited October 4, 2018 by lanista

[Ossy]

1 hour ago, robblok said:

You, with your number one badge for lack of reading skills, should try to read slower. You would have been right, if the actual percentage of budget allocation had not gone up to, too. But no … you failed in reading.

Oh-oh, robblock . . . it looks like someone's got their school-teacher's hat on today. Rather than argue over budget terminology, with the generally wise-speaking Mr C, maybe you could concentrate on a few grammar basics. With 3 commas and an ellipsis gone AWOL and a 'to' needing attention, too, maybe it's good to consider taking a less fault-finding approach. ????

[Fex Bluse]

3 hours ago, gk10002000 said:

One can expect the hospitals to be crushed and many go out of business similar to what happened in Los Angeles California when the Emergency Rooms were used by all the uninsured and for any and all ailments.

And similar to insured Americans who, though they are insured, costs the system disproportionately due to their often lazy, obese lifestyle diseases.

 

The costs are not spread evenly. Just because someone is paying does not mean they are not abusing. 

[Ossy]

14 minutes ago, Samui Bodoh said:

Hi Ossy

 

I was being sarcastic.

 

I should know better; sarcasm often does not work on this Forum.

 

Rest assured, I am very much in solidarity with the poor and against those who believe that the poor should be forced to die in the street.

 

In a civilized society, health care is a right, not a privilege.

 

 

Phew . . . that's a relief! ????  And you're right regarding the use of sarcasm. It can be very hit or miss, depending on the seriousness of the issue . . . as well as the mood of the reader ????

Edited October 4, 2018 by Ossy
omisson

[cmsally]

1 hour ago, robblok said:

Has nothing to do with the junta, they have actually increased the health budget. The health budget both in a percentage and actual figures is higher now then it was under the PTP with YL. 

 

But that still is not enough... because of the free healthcare that was never funded properly. Instead of blaming the junta without any proof maybe you should stick to facts.

 

 

 

 

 

Looking at the statistics even just the military budget doesn't seem to particularly follow what is reported elsewhere.

 

[phrisco17]

5 hours ago, davehowden said:

So many are sick through poor diet, alcohol and substance abuse, and so few contribute to the Health Care system through taxes other than VAT, what can anybody expect ?

Not even VAT... It is reported that only 4% of the population pay income tax and I assume that same 4% (and tourists) pay the largest share of the collected VAT. The majority buy where VAT is not charged, i.e. local markets, small shops/resturants or the street .

Edited October 4, 2018 by phrisco17

[Cadbury]

5 hours ago, webfact said:

PUBLIC HEALTH Ministry permanent secretary Dr Sukhum Kanchanapimai yesterday admitted that the country's hospitals were overwhelmed, following an outspoken doctor's comment that the condition was "close to collapse".

After reading the story I amazed there is no comment about how they intend finding a solution to this potential health disaster other than to make some directional changes to the healthcare system. That in plainspeak means nothing more than rearranging the deckchairs.

It is funding the hospitals need; how they get the funding is the problem they need to solve. The second problem is making sure the hospitals get ALL the funding, not just what's left over after civil servants get their greedy paws on it and siphon off what they think is theirs.  

I don't read anywhere about a committee being formed which is the usual method used not to have to make a decision. That in itself looks hopeful that some rescue plan might eventually come to pass. 

 

[Ossy]

38 minutes ago, Orton Rd said:

Figures on a chart and accounts mean nothing her

True, I'm sure, Orton Rd, and for the sad reason that, with this and other regimes, they've employed 'specially' skilled accountants to do the accounting . . . artistic accounting is perhaps a good name for it.

[Ossy]

48 minutes ago, robblok said:

And before nothing got stolen ? your logic is failing. 

You'll be driving this debate to a roadblock, robblok, if you're not careful. Ah, so that's how you got your name! ????

[Epidemiologist Dave]

The problem of overstaffing in the non medical staff needs to be addressed.

Yesterday while waiting for my wife at a government hospital a van with a driver and a passenger drew up and waited for two men to unload clinical waste bags from it. 

There were 4 bags. Then another three men arrived to clear a small blocked drain. Two stood and smoked next to a no smoking sign while the third cleared the drain. 

They then waited for a van to take them and one shovel back to the maintenance depot - 150 metres.

My solution? For a start cut non essential staff and raise the minimum fee to 50 baht.

[Srikcir]

1 hour ago, robblok said:

Has nothing to do with the junta, they have actually increased the health budget. The health budget both in a percentage and actual figures is higher now then it was under the PTP with YL. 

 

But that still is not enough... because of the free healthcare that was never funded properly. Instead of blaming the junta without any proof maybe you should stick to facts.

 

 

 

So Health receives a whopping 0.3% increase. Compared to Prayut's Defense budget increases, hardly a speck. The Health budget is like a tick on the back of an elephant.

 

Since the coup in 2014, the budget allocated to the Defense Ministry has increased substantially. For the fiscal 2015 national budget, the Defense Ministry budget jumped to Bt192.9 billion from Bt184.7 billion the year before. The defense budget was again raised substantially to Bt203.7 billion in fiscal 2016 and Bt221.7 billion for 2017.

http://www.nationmultimedia.com/news/business/EconomyAndTourism/30316243

The 2017 defense budget amounted to 210.7 billion Thai baht ($6.1 billion). The figure is a modest increase of 220 million Thai baht over the 2016 defense budget, or about 2 percent.

https://thediplomat.com/2016/09/the-truth-about-thailands-2017-defense-budget-hike/

Documents published by the government’s Bureau of the Budget show that the new expenditure is an increase of THB9.16 billion – or 4.2% - over actual defense spending in 2018.

https://www.janes.com/article/80722/thailand-sets-usd7-billion-defence-budget-for-2019

Note that the stated Defense budgets are understated:

• budgets in various other ministries such as the Interior and independent organizations such as the Election Commission include amounts to reimburse the military for "support services"
• part of defense budgets includes annual debt service (principle & interest) for foreign military procurement wherein the total purchase cost is amortized over several years so the total cost is not readily visible.

In Defense budget increases since 2014 there is rarely (if at all) justification for its increases. The government reportedly now spends about 12 billion baht (based on recent daily minimum wage increase) annually in salaries for new conscripts. And that likely doesn't include compensation paid for permanent conscript injuries or death. The savings from simply eliminating compulsory military service and associated military training costs could help support Health.

[robblok]

19 minutes ago, cmsally said:

 

 

Looking at the statistics even just the military budget doesn't seem to particularly follow what is reported elsewhere.

 

I see it as pretty accurate but I do a conversion here because your graph is in an other currency divide by an average dollar rate and it gets a lot closer. 

[Ossy]

2 hours ago, colinneil said:

I agree with you 100% staff at khonkaen hospital do a fantastic job, under very difficult conditions.

Five years ago today i was admitted there, doctors gave me a 10 % chance of surviving, yet i am still here five years later thanks to the skill and dedication of doctors and nurses.

I nearly entered a  there, for a moment. Nice one, Colin.

[robblok]

3 minutes ago, Srikcir said:

So Health receives a whopping 0.3% increase. Compared to Prayut's Defense budget increases, hardly a speck. The Health budget is like a tick on the back of an elephant.

 

Since the coup in 2014, the budget allocated to the Defense Ministry has increased substantially. For the fiscal 2015 national budget, the Defense Ministry budget jumped to Bt192.9 billion from Bt184.7 billion the year before. The defense budget was again raised substantially to Bt203.7 billion in fiscal 2016 and Bt221.7 billion for 2017.

http://www.nationmultimedia.com/news/business/EconomyAndTourism/30316243

The 2017 defense budget amounted to 210.7 billion Thai baht ($6.1 billion). The figure is a modest increase of 220 million Thai baht over the 2016 defense budget, or about 2 percent.

https://thediplomat.com/2016/09/the-truth-about-thailands-2017-defense-budget-hike/

Documents published by the government’s Bureau of the Budget show that the new expenditure is an increase of THB9.16 billion – or 4.2% - over actual defense spending in 2018.

https://www.janes.com/article/80722/thailand-sets-usd7-billion-defence-budget-for-2019

Note that the stated Defense budgets are understated:

• budgets in various other ministries such as the Interior and independent organizations such as the Election Commission include amounts to reimburse the military for "support services"
• part of defense budgets includes annual debt service (principle & interest) for foreign military procurement wherein the total purchase cost is amortized over several years so the total cost is not readily visible.

In Defense budget increases since 2014 there is rarely (if at all) justification for its increases. The government reportedly now spends about 12 billion baht (based on recent daily minimum wage increase) annually in salaries for new conscripts. And that likely doesn't include compensation paid for permanent conscript injuries or death. The savings from simply eliminating compulsory military service and associated military training costs could help support Health.

Nobody is arguing here about the defense budget, its the health budget that has also gone up. The defense budget like you so rightly point out has increased and should not have decreased. I agree 100%, this however has no influence on the fact that the junta spend more money then the previous governments on healthcare. True or not ?

[robblok]

28 minutes ago, Ossy said:

Oh-oh, robblock . . . it looks like someone's got their school-teacher's hat on today. Rather than argue over budget terminology, with the generally wise-speaking Mr C, maybe you could concentrate on a few grammar basics. With 3 commas and an ellipsis gone AWOL and a 'to' needing attention, too, maybe it's good to consider taking a less fault-finding approach. ????

Shall we debate in my native language ? This is not my first language.. plus you keep getting my name wrong.. so what about that.

 

The generally wise speaking Mr C does not accept his failings. I was quite clear about the budget its obvious that Mr C is not schooled in finance and either read too fast or just did not understand it. 

 

If a budget goes up in both amount and percentage of then its an increase in spending no matter how you look at it. If he had been graceful about it I would not have attacked him but he started calling me a junta defender so why should i stay polite. 

 

I deal in facts even if they are not liked by those opposing the junta. I even gave Thaksin credit for universal health even though i dislike the guy. There is enough that this junta messed up without inventing new stuff.

[robblok]

13 minutes ago, Ossy said:

You'll be driving this debate to a roadblock, robblok, if you're not careful. Ah, so that's how you got your name! ????

You can't debate stuff that is not quantify able, so why would i get into a debate that is not logical there is no way to know if more or less is stolen. Once can only assume over time its the same if you assume otherwise you have to prove it.

[Ossy]

2 hours ago, robblok said:

why they don't let everyone pay 400-500 bt a month like the people who work

Sorry if it seems I'm gunning for you, today, robblock, but does the above quote mean that you think that people who don't work should pay-up, just like the people who do? When many of those who don't work don't have a penny - from benefits or any other support - to their name, that seems somewhat harsh, to say the least.

[poohy]

3 hours ago, Cadbury said:

This 

Military governments by their very nature are not the milk of human kindness; they pretend they are but when it comes to a decisions between buying weaponry and financing hospitals it will be the submarines and tanks that will win every time.

This latest health crisis is indicative of the way the junta is leading the country backwards. Education is also in trouble and is in a state of dysfunction, incompetence and is steeped in corruption. yet the leader immerses himself in matters of importance such as feeding pigeons. 

If PM Prayut and his junta electoral team win the coming election the future looks bleak indeed for the poor people of Thailand. The friends of the junta and the rich and corrupt will prosper even more than they do now.

Perfect comment re Thailand and its government i have been here 20 years and the country is simply going backwards

[Shoeless Joe]

I agree with what Robblock says about the transparent year-on-year increases (both in percentage and "real" terms for healthcare spending). But I think he would agree that it's a mainly one-dimensional view because it's not just about the increases, it's also about where and how the money is spent.

 

One of the ways to release the pressures on hospitals and secondary care is to ensure that at least some of the additional funding is diverted towards a more robust primary healthcare system. There are some excellent primary care services but they're not well enough advertised and indeed, using my own Thai family as an example, there are many Thais ever-willing to descend on a hospital for very minor ailments rather than seek out a primary care solution (which might require a payment). Of course, clinical services (other than those in hospitals) need to be available throughout a 24/7 period and that's going to be difficult to promote. Community hospitals are also suffering from high attendances because it seems inherent in Thai people to adopt the "I must be treated in hospital" pathway. Pharmacists are also good advisors regarding various treatments for simple problems and they generally recognise when someone needs a different / higher level of care.

 

Of course, another problem is that the funding is generally made available directly to hospitals and secondary care centres who are loath to do anything but invest the money in their own services (because they have ever-growing pateint numbers). This becomes a blockage regarding onward investment in other services. It's also possible that some money destined for clinical services gets siphoned off in a number of "dubious" ways, but there seems to be no real accountability for spending and even on the odd occasion when someone is caught with their hand in the till it only leads to censure of officials by the government, there's no evidence of meaningful punishments being handed down. Until the internal corruption issues are solved then there's always going to be a mismatch between avaialble funding and truly accountable spending processes. (In the course of a conversation with a highly regarded Chiang Mai orthopaedic consultant recently, he said that in the past 20 years he coudn't recall ONE financial audit taking place in the government hospital where he worked. But in the private hospital where he worked there was a full financial audit every 2 years, undertaken by an outside agency)...

 

This is not a problem that can be solved easily or quickly. It requires a top-down level of strategic planning and modelling covering a minimum of the first 10 years; it requires a comprehensive healthcare review and a complete rethink about how clinical services should be delivered; it requires a long-term, sustainable health education programme. But most of all it requires acceptance and "buy-in" from all senior government officials and agencies. Also, endorsement by the King as one of his "new" projects would likely prove invaluable.

 

Regards,

 

Joe

Edited October 4, 2018 by Shoeless Joe

[robblok]

21 minutes ago, Ossy said:

Sorry if it seems I'm gunning for you, today, robblock, but does the above quote mean that you think that people who don't work should pay-up, just like the people who do? When many of those who don't work don't have a penny - from benefits or any other support - to their name, that seems somewhat harsh, to say the least.

What i am saying is that there are many who work but don't pay into this system. Remember only if your officially employed and paying taxes then you pay extra for healthcare. So i find it quite unfair that many who do have jobs self employed and so on don't pay a penny in the system. 

 

The whole problem is that the system is under funded, real poor unemployed people should of course have access to the system.

[cmsally]

14 minutes ago, Shoeless Joe said:

I agree with what Robblock says about the transparent year-on-year increases (both in percentage and "real" terms for healthcare spending). But I think he would agree that it's a mainly one-dimensional view because it's not just about the increases, it's also about where and how the money is spent.

 

One of the ways to release the pressures on hospitals and secondary care is to ensure that at least some of the additional funding is diverted towards a more robust primary healthcare system. There are some excellent primary care services but they're not well enough advertised and indeed, using my own Thai family as an example, there are many Thais ever-willing to descend on a hospital for very minor ailments rather than seek out a primary care solution (which might require a payment). Of course, clinical services (other than those in hospitals) need to be available throughout a 24/7 period and that's going to be difficult to promote. Community hospitals are also suffering from high attendances because it seems inherent in Thai people to adopt the "I must be treated in hospital" pathway. Pharmacists are also good advisors regarding various treatments for simple problems and they generally recognise when someone needs a different / higher level of care.

 

Of course, another problem is that the funding is generally made available directly to hospitals and secondary care centres who are loath to do anything but invest the money in their own services (because they have ever-growing pateint numbers). This becomes a blockage regarding onward investment in other services. It's also possible that some money destined for clinical services gets siphoned off in a number of "dubious" ways, but there seems to be no real accountability for spending and even on the odd occasion when someone is caught with their hand in the till it only leads to censure of officials by the government, there's no evidence of meaningful punishments being handed down. Until the internal corruption issues are solved then there's always going to be a mismatch between avaialble funding and truly accountable spending processes. (In the course of a conversation with a highly regarded Chiang Mai orthopaedic consultant recently, he said that in the past 20 years he coudn't recall ONE financial audit taking place in the government hospital where he worked. But in the private hospital where he worked there was a full financial audit every 2 years, undertaken by an outside agency)...

 

This is not a problem that can be solved easily or quickly. It requires a top-down level of strategic planning and modelling covering a minimum of the first 10 years; it requires a comprehensive healthcare review and a complete rethink about how clinical services should be delivered; it requires a long-term, sustainable health education programme. But most of all it requires acceptance and "buy-in" from all senior government officials and agencies. Also, endorsement by the King as one of his "new" projects would likely prove invaluable.

 

Regards,

 

Joe

 

First just like to say thank you for an excellent post !

In Thailand there seems to be no system of "General Practice" with a separate place you can go to for general ailments and see a regular doctor . There are some smaller clinics but nothing on the scale required to try and keep a massive amount of people away from the hospitals when they can be treated somewhere smaller.

 

Smoking and drinking problems have probably improved in the last decades, but the quality of food leaves a lot to be desired and is going to cause a lot of health problems in the future.

[mauGR1]

3 minutes ago, robblok said:

What i am saying is that there are many who work but don't pay into this system. Remember only if your officially employed and paying taxes then you pay extra for healthcare. So i find it quite unfair that many who do have jobs self employed and so on don't pay a penny in the system. 

 

The whole problem is that the system is under funded, real poor unemployed people should of course have access to the system.

In a nutshell, the system is unsustainable.