Hospitals close to collapse: Thai official

[cmsally]

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.

 

A lot of self employed people / business owners would love to pay into the "Prakan Sangkom" system but are not allowed to. It is only open for employees.

[robblok]

17 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

Of course i agree that is a one dimensional view, but its all we can measure right now. All i do is comparing real facts.. not feelings. 

 

This problem exists because of the free healthcare by Thaksin (great plan) and then the not funding of it by all governments (bad). So i feel its unfair to blame the junta for this. They have many failings and I will attack them on those. However if they are blamed for something they are not to blame for I will defend them. Same like I give Thaksin credit for his plan even though i dislike the guy (just like i dislike the junta).

 

I agree 100% that the hospitals could be fraudulent too.. but i doubt it was any different in the past, the goverment could send in more accountants and more checks.. maybe that would work. But in a country where corruption is so wide spread you can't even trust the people checking stuff.

 

I hope they do change stuff and cut corruption down but i feel it will take a long time to see improvement. Plus you cant have first world expectations if you dont fund it.. and if people dont pay for it. 

 

 

[robblok]

1 minute ago, cmsally said:

 

A lot of self employed people / business owners would love to pay into the "Prakan Sangkom" system but are not allowed to. It is only open for employees.

Why ? I mean they are entitled to the same benefits with or without payment ?

 

Or am I wrong here ? (i could be wrong i do know that government officials get better treatment).

[moe666]

3 hours ago, robblok said:

That is the problem from free healthcare.. its great.. but its not free. Thaksin was good for starting free healthcare but no government ever funded it enough. Now we see what it leads too.. hospitals that can't cope with the number of patients.

 

You can't just give free healthcare and then not fund the hospitals enough. But it would be a huge drain on the budget if they do. Too few people actually pays, why they don't let everyone pay 400-500 bt a month like the people who work is strange to me.  Its shameful how some people pay for it but get bad service because others don't pay for it.

 

Fund the hospitals more, take money from the army, and from the people. Everywhere free healthcare cost money here there are too many people using the system but not paying a dime.

But what is the real drain, tanks, subs, and a super train. I come from the US worst medical care in the world if you do not have money. Even if you have money not very good.

Thailand has a ageing population and they really didn't plan for it

[robblok]

3 minutes ago, mauGR1 said:

In a nutshell, the system is unsustainable.

With the current funding.. YES

[cmsally]

Quite honestly I would divert most of the money that goes to temples into healthcare. Looking at some of the money that goes into temples, it could mean the funding problem was solved overnight.

[cmsally]

They could also put aside a portion of lottery fund profits to healthcare.

[robblok]

1 minute ago, cmsally said:

Quite honestly I would divert most of the money that goes to temples into healthcare. Looking at some of the money that goes into temples, it could mean the funding problem was solved overnight.

Or take money away from the army (not going to happen). Same like i doubt they will take money away from temples. But there needs to be a serious increase of funding one way or the other otherwise this system will collapse. 

[Eric Loh]

Most of the problems are well documented. Just need a leader who have the wisdom and vision to solve these problems.

1. Increased workload and dissatisfaction of healthcare personnel

2. Conflicts between MOPH and NHSO who are the main providers and financial supporters has now resulted on low morale and a wave of unhappiness and satisfaction

3. Budget allocation not equatable 

4. Funding issues - only the Social Security Scheme is self funded by employees contribution. The Civil Service and Universal Coverage (90% of funding) by General Tax revenues. 

 

UHC has done a lot of good for Thailand in the overall health of the country. Life expectancy has increased from 57/61 in '64 to 70/77 years now (men/women respectively). Infant mortality rate and Maternal Mortality rate have improved significantly.  

 

 

[Ossy]

1 hour ago, cmsally said:

 

 

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

 

I like the comparing dynamic, but the 2017 figure ($6,075.7M wh equates to 198 billion baht) is slightly lower than the budget statement. Is that how you see the comparison? I was expecting you to be blasting the junta defence figure as dubious.

[robblok]

5 minutes ago, Eric Loh said:

Most of the problems are well documented. Just need a leader who have the wisdom and vision to solve these problems.

1. Increased workload and dissatisfaction of healthcare personnel

2. Conflicts between MOPH and NHSO who are the main providers and financial supporters has now resulted on low morale and a wave of unhappiness and satisfaction

3. Budget allocation not equatable 

4. Funding issues - only the Social Security Scheme is self funded by employees contribution. The Civil Service and Universal Coverage (90% of funding) by General Tax revenues. 

 

UHC has done a lot of good for Thailand in the overall health of the country. Life expectancy has increased from 57/61 in '64 to 70/77 years now (men/women respectively). Infant mortality rate and Maternal Mortality rate have improved significantly.  

 

 

The only solution that i see is extra funding (plus extra checks of course).

Problem is where will the funding come from.. nobody wants to pay more tax. So that would mean taking away money from other departments.. that wont be easy.

[cmsally]

In my opinion one of the key failings of the Thai system in the last few years is the systematic decimation of the middle class. Politically they desire a cash strapped majority who are tied to employment contracts/ government service / poverty. This situation will not create a majority sector who have income to pay for health care.

Ideally you should have the majority of the population paying into the Social Health Care system including business owners . As well as this you should have healthcare deducted from income of government workers.

[Ossy]

15 minutes ago, cmsally said:

Quite honestly I would divert most of the money that goes to temples into healthcare. Looking at some of the money that goes into temples, it could mean the funding problem was solved overnight.

Any idea how much that is? A have always thought, naively maybe, that the Buddhist infrastructure was self-funded by collections from the super-generous followers.

[mauGR1]

2 minutes ago, cmsally said:

In my opinion one of the key failings of the Thai system in the last few years is the systematic decimation of the middle class. Politically they desire a cash strapped majority who are tied to employment contracts/ government service / poverty. This situation will not create a majority sector who have income to pay for health care.

Ideally you should have the majority of the population paying into the Social Health Care system including business owners . As well as this you should have healthcare deducted from income of government workers.

I think this applies more or less to every country of the world.

Troubles ahead, for sure.

[robblok]

6 minutes ago, Ossy said:

Any idea how much that is? A have always thought, naively maybe, that the Buddhist infrastructure was self-funded by collections from the super-generous followers.

Actually and I could be wrong.. i see it in the pictures i posted and the amount is minor less then 1% of the taxes they get. So im not sure it would solve the problem. I assume that the post Recreation culture and religion is where the temple expenses would be 

[Ossy]

15 minutes ago, robblok said:

The only solution that i see is extra funding (plus extra checks of course).

Problem is where will the funding come from.. nobody wants to pay more tax. So that would mean taking away money from other departments.. that wont be easy.

I would argue that a 'good' government would find it very easy to take money away from other sectors, without acting irresponsibly, and I'm sure I needn't say which those might be.

[robblok]

2 minutes ago, Ossy said:

I would argue that a 'good' government would find it very easy to take money away from other sectors, without acting irresponsibly, and I'm sure I needn't say which those might be.

You and I then would have an argument because the amount of extra funding needed is quite big and the departments that had to pay would not like that.

 

I see it every year in my country the debates that even small shifts bring out.. we are talking here about a major shirt of money that is bound to ruffle some feathers.

 

I do think that the army and police could lose some funding but it wont happen for sure. 

[Eric Loh]

21 minutes ago, robblok said:

The only solution that i see is extra funding (plus extra checks of course).

Problem is where will the funding come from.. nobody wants to pay more tax. So that would mean taking away money from other departments.. that wont be easy.

Maybe the government should change their thinking and look at UHC for the 48 million poor as a moral responsibility and not a burden. A moral responsibility to narrow the inequality gap, relieve people'financial burdens and allowing them a chance to improve their economic status so they can contribute back to society and create economic values to the country. Besides, I don't think the government has exhausted ways to tax for extra revenues. Just need wisdom and visionary leaders. 

[robblok]

1 minute ago, Eric Loh said:

Maybe the government should change their thinking and look at UHC for the 48 million poor as a moral responsibility and not a burden. A moral responsibility to narrow the inequality gap, relieve people'financial burdens and allowing them a chance to improve their economic status so they can contribute back to society and create economic values to the country. Besides, I don't think the government has exhausted ways to tax for extra revenues. Just need wisdom and visionary leaders. 

Eric,

 

I doubt it will happen under junta or civilian government.. they can't steal enough from the hospitals. They rather put money in big construction projects and so on where they can take their cut. 

 

I do wonder why they never funded it enough in the past... if only they had put the money of the rice scam in the hospitals there would not have been any problems now. But as i said hard to steal money from so not a popular way of spending money. Same goes for tanks.. and subs.. easy to take a cut.. not easy to take a cut from hospital expenses.

Call me jaded.. but I think this is at least part of the reason. I don't see anyone talking about major increases in health spending. 

[Eric Loh]

19 minutes ago, robblok said:

Eric,

 

I doubt it will happen under junta or civilian government.. they can't steal enough from the hospitals. They rather put money in big construction projects and so on where they can take their cut. 

 

I do wonder why they never funded it enough in the past... if only they had put the money of the rice scam in the hospitals there would not have been any problems now. But as i said hard to steal money from so not a popular way of spending money. Same goes for tanks.. and subs.. easy to take a cut.. not easy to take a cut from hospital expenses.

Call me jaded.. but I think this is at least part of the reason. I don't see anyone talking about major increases in health spending. 

 

Thailand healthcare budget as a percentage of GDP or annual budget is still modest in comparison with world. Just a small twitch in defence spending and resist the ego temptation to buy the submarines and planes would easily solve the funding problem. 

[heybuz]

Before national health care in my home country one state ran a free hospital system solely of the profits of a lottery.

[robblok]

1 minute ago, Eric Loh said:

 

Thailand healthcare budget as a percentage of GDP or annual budget is still modest in comparison with world. Just a small twitch in defence spending and resist the ego temptation to buy the submarines and planes would easily solve the funding problem. 

 

I guess I have to disagree (with the second part not the first part).

 

It would not require a small twitch.. i think to make the hospitals better it would at least take an 20% increase in budget. That would mean a 25-30% decrease in army spending.. That is not a small twitch at all. We are talking about serious numbers here. 

 

Maybe you and I have a difference of opinion on how much is needed.. or on what we consider small.

[hotchilli]

Why not set up community health centres manned by general practitioners who would serve as community doctors.

They would then investigate patients and treat them for minor ailments not needing to visit a hospital, and have the ability to issue prescriptions for medication.

Only those who need hospital treatment would be given an appointment to see a specialist at the appropriate hospital in the region.. thus cutting waiting time.

I've see people go to a hospital and sit there in a huge queue with others with no more than a headache, earache or common cold!

[marko kok prong]

Sounds like the NHS in Uk

[usacb500biker]

I use Gov hospital 2 times in 2017, waited 8 hours, see student Doctor,cost 1200--1500B. 28 blood tests 200B,EKG 300B, X-Ray 200B,3 inhalders, heart Meds and see Doc.... Thai"s Free...Only 3 Farangs and 500 Thai"s......don"t  Blame Me......

[wabothai]

2 hours ago, hotchilli said:

Why not set up community health centres manned by general practitioners who would serve as community doctors.

They would then investigate patients and treat them for minor ailments not needing to visit a hospital, and have the ability to issue prescriptions for medication.

Only those who need hospital treatment would be given an appointment to see a specialist at the appropriate hospital in the region.. thus cutting waiting time.

I've see people go to a hospital and sit there in a huge queue with others with no more than a headache, earache or common cold!

Yes, and return home with a plastic bag full of medicin, which makes them even more reliant.

[Shoeless Joe]

7 hours ago, marko kok prong said:

Sounds like the NHS in Uk

Not really....The problems with the NHS are manifold and complex and it's not just about funding. Population expansion over the last 20 years has caused significant user problems; better treatment regimes and longer life spans means that looking after the ever-growing elderly numbers has created a funding shortfall; maintenance, refurbishment and development of capital estate needs to be funded; the ambulance service(s) also require money to stay on the road. For a long time there's been agreement amongst government(s) and doctors that a 2-tier health service needs to be introduced rapidly so that those who can afford it should pay (or contribute towards the cost) for some services while the NHS "as a whole" remains free for everyone at the point of entry.  As Robblok has alreay pointed out, where will the additional money come from? What do you want to sacrifice to pour additional funds into the NHS /Thai healthcare. You could start for instance with asking why the UK (and Thailand) needs an expensive Army, Navy and Air Force combined with the billions spent needlessly on armaments that will never be used. I regret that while the military are in charge they will always want to spend more on the "toys for the boys".

 

Regards,

 

Joe