Thai Physicians Now Face A Fresh Threat Of Financial Scrutiny

[webfact]

Physicians now face a fresh threat of financial scrutiny

By Chularat Saengpassa

The Nation

Move aims to counter unnecessary prescriptions costing govt billions

Physicians, already pressured by the treatment choices issue, now face a threat by the Comptroller General's Department (CGD) to seek help from the Revenue Department in scrutinising their financial assets.

Newly appointed CGD director-general Rangsan Sriworasart said the move was not intended to affect doctors, but is the most practical solution to deal with long-standing unnecessary prescriptions which may stem from doctors' secret deals with pharmaceutical companies leading to excessive medical spending for public servants.

"What we can do now is to stem leaking of the [treatment] costs, and we have detected that unnecessary prescriptions are the main reason for the leaking," he said in an interview with Krungthep Turakij.

About 4.7 million public servants are covered by the government health scheme, which in 2009 resulted in spending of as high as Bt61 billion, double the 2004 amount. This is enormous compared to the universal health scheme which entailed spending of Bt100 billion for 47 million people. Another 10 million Thais are covered by social security, which involved medical spending of about Bt40 billion last year. There were concerns that without controlling measures, government medical bills could rise to Bt100 billion in a matter of years.

Rangsan reiterated in the interview that while the department would look at ways to control spending on unnecessary and expensive drugs, this would have nothing to do with the benefits now enjoyed by public servants and contract workers.

"We will ask the Revenue Department for cooperation in looking into asset declarations by doctors, especially income from pharmaceutical firms. Certain payments are made but not declared in tax declarations by some doctors," he said.

The move is part of the national agenda to balance the national budget within five years. Thailand this year will run a budget deficit of Bt420 billion.

Besides the closer scrutiny of drug prescriptions, the CGD also promises to check on government funds, to maximise profits for the entire economy. Rangsan said altogether the funds sit on cash and assets worth more than a trillion baht, but many just deposit their cash and enjoy the deposit rates. More CGD officers will be nominated to join the committees that manage the fund, he said.

Strengthening its scrutiny, the CGD is likely to add further discomfort to physicians nationwide who have been told to control their medical costs.

In an interview with The Nation, Utai Puntippong, a heart doctor who has worked at a Chanthaburi hospital for 20 years, said the CGD's order posed problems for doctors as the bills became their priority rather than the best way to cure patients.

"Public servants have enjoyed the best medical assistance. But now, the standards are lowered. Instead of pushing the universal health standard to match the public one, the National Health Commission Office and CGD are lowering the public standard," said the doctor.

He acknowledged that stricter control could stem from some corrupted doctors who prescribe for commission expensive medicines rather than those on the standard drug list, leaving all patients at [risk of being] disadvantaged.

The CGD recently issued a standard drug list. Any doctor prescribing other drugs would have to risk their bills not being approved by the department, leaving the cost to be shouldered by the doctors and their hospitals. Meanwhile, for heart doctors, the CGD also approved a list of stents. To Utai, not all stents fit all patients.

"Now, I have to prescribe only drugs on the list, though the effectiveness may be lower for some patients. We can't bear the financial responsibility. The government allocates us a sum for each year and leaves us to decide how to spend it. If any is left, all would be returned to the department - but if we spend over the sum, we have to shoulder it. If my prescription is valued over Bt500, I would be summoned for a discussion with the hospital director. Some patients stay far away from the hospital. Though I want to give them a larger volume to save their travelling time, I can't."

Utai said that given the mounting pressure, he would resign from the hospital next year.

"At the 7th level, I earn about Bt30,000 in salary plus an extra allowance of Bt10,000. Before, I turned down an offer of a Bt500,000 salary to work for a private hospital. Then, I was comfortable with treating patients at public hospitals given that we can give them the best. Now, we have to talk to patients if they can shoulder the extra burden. Our treatment techniques and equipment is now under control, by some who are not doctors."

On August 3, the National Health Commission Office, the CGD, Social Security Fund, the Public Health Ministry and the Health Systems Research Institute signed a pact to jointly develop an information centre. Through the centralised data system, they can analyse the size of population and medical spending involved. The signing followed the estimate that the three national health schemes -for public servants, those who hold the Bt30 medical cards, and social security workers - would double from Bt200 billion in the next 5 years to up to Bt400 billion.

-- The Nation 2010-10-04

[wasabi]

Most Thai Docs never met an antibiotic they didn't like.

[jybkk]

Most Thai Docs never met an antibiotic they didn't like.

Exactly.

In European medical schools, Thailand is given as an example of one of the countries blatantly over-prescribing antibiotics.

But the concern is not just about money, it is a public health problem too. Overuse of antibiotics breeds resistant strains.

If I understand this article correctly, doctors revenue comes partly from the benefits generated by the medicine prescribed. There's a huge conflict of interest here, no?

They are supposedly the only ones able to tell you what you really need, and in the meantime, their objective is to sell you as much as they can.

It's a good thing the government is looking into that, I'd like the Medical Council (or whatever medical regulatory body it is here) to look into the ethical part of this business.

[moe666]

medicine the world over is corrupt with the drug companies paying doctors to prescribe any and everthing.

[kyb789]

My brother is a doctor in the U.S He gets lavish free vacations to Lake Tahoe and Hawaii and enough free samples to fill his suitcase, all paid for by the drug companies. All he has to do is attend a 2 hr seminar during his trip. And we wonder why the cost of drugs is so high.

[bushwacker]

Most Thai Docs never met an antibiotic they didn't like.

Exactly.

In European medical schools, Thailand is given as an example of one of the countries blatantly over-prescribing antibiotics.

But the concern is not just about money, it is a public health problem too. Overuse of antibiotics breeds resistant strains.

If I understand this article correctly, doctors revenue comes partly from the benefits generated by the medicine prescribed. There's a huge conflict of interest here, no?

They are supposedly the only ones able to tell you what you really need, and in the meantime, their objective is to sell you as much as they can.

It's a good thing the government is looking into that, I'd like the Medical Council (or whatever medical regulatory body it is here) to look into the ethical part of this business.

You do not even need a doctor. Just walk into your nearest drug store and by the antibiotics over the counter. No problem, easy!

The other problem is with the Thai general public. If a doctor only gives you one drug then the general feeling is that the doctor is not any good. Thai people feel that a good doctor would give you 4-7 different medicines. And they only want to have the good doctors care for them.

This has happened to me several times. I had an eye problem a year ago and went into a good private hospital to see a doctor. I walked out with 6 drugs and only one to cure the problem. The other 5 had nothing to do with my issue. For example, i received cream to apply to take away the itch (even though there was no itch). A pill to help me sleep (even though i was sleeping fine). etc I guess i was lucky to have found a good doctor. I am not complaining because i was cured and the all the medicine cost about $17 (a screaming deal hihihihihihi)

[geriatrickid]

The days of big pharma companies offering kickbacks on scripts is over. Just ask the big multinationals that have paid out hundreds of millions of dollars/euros in settlements. The conduct of biggies like Astra Zeneca, Pfizer etc. in Thailand is still subject to sanctions from the EU and USA. Big pharma is very careful now, especially since a certain company which was engaged in conduct allowed in the EU was nailed for sanctions by the US FDA.

However, the inappropriate incentive programs and alleged kickbacks are problem in Thailand because it involves local and regional pharma companies that are not subject to oversight. Although the GSKs and Roches of the EU do behave with some semblance of ethics, IMO that is not the case with SE Asian and Indian manufacturers. I don't think a manufacturer in India cares for ethical practices in quite the same way as a US based company.

[Bagwan]

I was told by a doctor only a couple of weeks ago that she feared for the health of her grandchildren as after she died there would not be a doctor in the family.. She said, unprompted by myself, that most of the current crop of young doctors were well below the required standard and that all were primarily interested in money and not their patient. 

I suggest that anybody who consults a doctor at a private hospital should tell them that they will only pay for remedies that treat the ailment and not those that alleviate the symptoms. Cure the problem, not the evidence in other words. Those who feel really strongly should, after taking note of the medication, refuse it and hurry off to the nearest high street pharmacy.

My experience built up over several years is that lady doctors in Thailand are more caring, appear to be more knowledgeable, are more ethical - and most of all - more honest.  

[Deeral]

THe medical industry in Thailand is a lottery.It is corrupt, badly trained and only concerned with money.

If you end up in a Thai hospital - even a hi-so private one GOD HELP YOU!

[Pib]

When ever any of my Thai in-laws go to a clinic/hospital for whatever type of ailment, they are almost always prescribed a boat load of various medications. And you know what, unless the in-laws get a fair amount of medications (free or at a charge) they don't feel like they were properly cared for. It seems to almost be a mindset that a person is suppose to be prescribed a lot of meds when visiting the doc. More meds the better, even if they are only very common/buy anywhere type meds.

[ableguy]

medicine the world over is corrupt with the drug companies paying doctors to prescribe any and everthing.

I read this article today and the only thing that crossed my mind was thank god its out in the open. Now rest assured we will never hear about it again.

[Somnambulist]

The days of big pharma companies offering kickbacks on scripts is over. Just ask the big multinationals that have paid out hundreds of millions of dollars/euros in settlements. The conduct of biggies like Astra Zeneca, Pfizer etc. in Thailand is still subject to sanctions from the EU and USA. Big pharma is very careful now, especially since a certain company which was engaged in conduct allowed in the EU was nailed for sanctions by the US FDA.

However, the inappropriate incentive programs and alleged kickbacks are problem in Thailand because it involves local and regional pharma companies that are not subject to oversight. Although the GSKs and Roches of the EU do behave with some semblance of ethics, IMO that is not the case with SE Asian and Indian manufacturers. I don't think a manufacturer in India cares for ethical practices in quite the same way as a US based company.

I used to think this way too - Our American companies may do some bad things now and then but they do more good than harm and certainly must be better than those dirty foreign companies. After all, we were all taught in grade school that the U.S. is number one in every way. 25 years of living abroad has lifted the fog for me.

[swifty5x5]

Physician heal thyself.

[japatee]

In ancient china you only paid your village doctor if you remained healthy.. How things have changed

[bobmac10]

The real issue here is the same as in Western countries (albeit a little less severe) and that is pharmaceutical companies offering incentives to medicos to prescribe their drugs to patients.

In the west it's in the form of lavish medical conferences in exotic locations (all expenses paid) and we still haven't been able to stop the problem.

Thailand is just less advanced when it ncomnes to the incentives offered.

The other concern is the patient's expectation that he hasn't really received value from his visit to the doctor unless he leaves with a great number of pills. It's all up to the doctors to fix the problem themselves.

[Tigs]

One problem is that Thais think Doctors hold some amazing unquestionable status. I have taught my wife otherwise during any visits we have made with our Children. We use the same Doctor, who has learned that I wont take any bullsh*t and that he is being paid to provide a service to me, and I am the client. I question him concerning any medications he is thinking of prescribing, but now he knows that unless it is required, dont mention it to me. It started when I first took my daughter with a viral infection and the Doc then prescribed antibiotics!! When I asked why he was prescribing antibiotics for a viral infection when they only work on Bacterial infections, he got the idea. He knows I am now happy to pay for a consultation but for any run of the mill general illnesses I dont want a bag full of medicines. He has also tried it on many times asking if I want a 'new' vaccination for the kids, only 2500 bht, after the barrage of 'what's it for, how long has it been out, where are the trial results, what are the side effects, why do they need it, etc etc etc he gives up and concedes that it is just another earner for the pharma companies.

The next door neighbours are for ever taking their children to the Doc, for anything, and come back with bags full of tablets that the Child needs. Indeed invariably the child just needs a bit of junior tylneol to bring their temp down, or some cough medicine, and tucked up in bed and a day off school. Not the next door folks, they have their kids admitted to hospital for 48 hours with a sore throat or cough. You have to take control, albeit politely with the Doctors. The hospitals are there to fill the beds, and in our town you are lucky to get a bed, because they are full of people who just shouldn't be in hospital, people in there for 24-48 hours with a sprained wrist or a headache! The hospitals don't care, they make money by filling the beds regardless of severity of ailment . Everybody wants their kids to be Doctors, because they know that the money is fantastic, and all the Docs have big houses and Mercs.

The investigation is a fantastic idea, if it will be conducted! It would be interesting to see accurate figures for the mismanagement of prescription medicines just to get money. Still I guess it is no different from the UK 40 years ago, when the school dentists used to come around and they were only paid for actual treatments they did, hence most people of my generation ended up with mouths full of mercury.

[Deeral]

The real issue here is the same as in Western countries (albeit a little less severe) and that is pharmaceutical companies offering incentives to medicos to prescribe their drugs to patients.

In the west it's in the form of lavish medical conferences in exotic locations (all expenses paid) and we still haven't been able to stop the problem.

Thailand is just less advanced when it ncomnes to the incentives offered.

The other concern is the patient's expectation that he hasn't really received value from his visit to the doctor unless he leaves with a great number of pills. It's all up to the doctors to fix the problem themselves.

I don't think you fully understand what Big Pharma does to push it's drugs.

In the west it varies from country to country quite dramatically but especially US it is outrageous, in Thailand it is COMPLETELY OUT OF CONTROL - literally - there is no enforcement of any kind whatsoever.

This is coupled with the ALTERNATIVE medicine industry and the absurdly powerful position of Doctors.

Add all this to a bourgeoning Medical Tourism industry and you have a recipe for disaster.

FYI - "Thelargest domestic drug manufacturer is the Government PharmaceuticalOffice (GPO) which has a near monopoly over the public hospitalsector in the country. Public hospitals are legally obliged topurchase 80% of their drugs from the GPO."

however what happens in private hospitals is anybody's business.

Edited October 6, 2010 by Deeral

[Deeral]

One problem is that Thais think Doctors hold some amazing unquestionable status. I have taught my wife otherwise during any visits we have made with our Children. We use the same Doctor, who has learned that I wont take any bullsh*t and that he is being paid to provide a service to me, and I am the client. I question him concerning any medications he is thinking of prescribing, but now he knows that unless it is required, dont mention it to me. It started when I first took my daughter with a viral infection and the Doc then prescribed antibiotics!! When I asked why he was prescribing antibiotics for a viral infection when they only work on Bacterial infections, he got the idea. He knows I am now happy to pay for a consultation but for any run of the mill general illnesses I dont want a bag full of medicines. He has also tried it on many times asking if I want a 'new' vaccination for the kids, only 2500 bht, after the barrage of 'what's it for, how long has it been out, where are the trial results, what are the side effects, why do they need it, etc etc etc he gives up and concedes that it is just another earner for the pharma companies.

The next door neighbours are for ever taking their children to the Doc, for anything, and come back with bags full of tablets that the Child needs. Indeed invariably the child just needs a bit of junior tylneol to bring their temp down, or some cough medicine, and tucked up in bed and a day off school. Not the next door folks, they have their kids admitted to hospital for 48 hours with a sore throat or cough. You have to take control, albeit politely with the Doctors. The hospitals are there to fill the beds, and in our town you are lucky to get a bed, because they are full of people who just shouldn't be in hospital, people in there for 24-48 hours with a sprained wrist or a headache! The hospitals don't care, they make money by filling the beds regardless of severity of ailment . Everybody wants their kids to be Doctors, because they know that the money is fantastic, and all the Docs have big houses and Mercs.

The investigation is a fantastic idea, if it will be conducted! It would be interesting to see accurate figures for the mismanagement of prescription medicines just to get money. Still I guess it is no different from the UK 40 years ago, when the school dentists used to come around and they were only paid for actual treatments they did, hence most people of my generation ended up with mouths full of mercury.

Actually you are overlooking why the British have a reputation for "wonky" teeth - the free national health serivce refused to pay practitioners for what they considered "cosmetic" dentistry - so very few people were fitted with "braces" - this would have been a much bigger money spinner for dentists - in fact it is the mainstay of dentistry with young people in the States.

Edited October 6, 2010 by Deeral

[Tigs]

One problem is that Thais think Doctors hold some amazing unquestionable status. I have taught my wife otherwise during any visits we have made with our Children. We use the same Doctor, who has learned that I wont take any bullsh*t and that he is being paid to provide a service to me, and I am the client. I question him concerning any medications he is thinking of prescribing, but now he knows that unless it is required, dont mention it to me. It started when I first took my daughter with a viral infection and the Doc then prescribed antibiotics!! When I asked why he was prescribing antibiotics for a viral infection when they only work on Bacterial infections, he got the idea. He knows I am now happy to pay for a consultation but for any run of the mill general illnesses I dont want a bag full of medicines. He has also tried it on many times asking if I want a 'new' vaccination for the kids, only 2500 bht, after the barrage of 'what's it for, how long has it been out, where are the trial results, what are the side effects, why do they need it, etc etc etc he gives up and concedes that it is just another earner for the pharma companies.

The next door neighbours are for ever taking their children to the Doc, for anything, and come back with bags full of tablets that the Child needs. Indeed invariably the child just needs a bit of junior tylneol to bring their temp down, or some cough medicine, and tucked up in bed and a day off school. Not the next door folks, they have their kids admitted to hospital for 48 hours with a sore throat or cough. You have to take control, albeit politely with the Doctors. The hospitals are there to fill the beds, and in our town you are lucky to get a bed, because they are full of people who just shouldn't be in hospital, people in there for 24-48 hours with a sprained wrist or a headache! The hospitals don't care, they make money by filling the beds regardless of severity of ailment . Everybody wants their kids to be Doctors, because they know that the money is fantastic, and all the Docs have big houses and Mercs.

The investigation is a fantastic idea, if it will be conducted! It would be interesting to see accurate figures for the mismanagement of prescription medicines just to get money. Still I guess it is no different from the UK 40 years ago, when the school dentists used to come around and they were only paid for actual treatments they did, hence most people of my generation ended up with mouths full of mercury.

Actually you are overlooking why the British have a reputation for "wonky" teeth - the free national health serivce refused to pay practitioners for what they considered "cosmetic" dentistry - so very few people were fitted with "braces" - this would have been a much bigger money spinner for dentists - in fact it is the mainstay of dentistry with young people in the States.

I wasn't overlooking the reason the British have wonky teeth. I am British have never had a brace, and don't have wonky teeth. I was talking about fillings in the back of the mouth and how school dentists were paid for the number they did, hence the comparison to Thai Doctors prescribing medicines for anything and everything. Your comment concerning braces may be accurate but is nothing to do with my post.

[Deeral]

One problem is that Thais think Doctors hold some amazing unquestionable status. I have taught my wife otherwise during any visits we have made with our Children. We use the same Doctor, who has learned that I wont take any bullsh*t and that he is being paid to provide a service to me, and I am the client. I question him concerning any medications he is thinking of prescribing, but now he knows that unless it is required, dont mention it to me. It started when I first took my daughter with a viral infection and the Doc then prescribed antibiotics!! When I asked why he was prescribing antibiotics for a viral infection when they only work on Bacterial infections, he got the idea. He knows I am now happy to pay for a consultation but for any run of the mill general illnesses I dont want a bag full of medicines. He has also tried it on many times asking if I want a 'new' vaccination for the kids, only 2500 bht, after the barrage of 'what's it for, how long has it been out, where are the trial results, what are the side effects, why do they need it, etc etc etc he gives up and concedes that it is just another earner for the pharma companies.

The next door neighbours are for ever taking their children to the Doc, for anything, and come back with bags full of tablets that the Child needs. Indeed invariably the child just needs a bit of junior tylneol to bring their temp down, or some cough medicine, and tucked up in bed and a day off school. Not the next door folks, they have their kids admitted to hospital for 48 hours with a sore throat or cough. You have to take control, albeit politely with the Doctors. The hospitals are there to fill the beds, and in our town you are lucky to get a bed, because they are full of people who just shouldn't be in hospital, people in there for 24-48 hours with a sprained wrist or a headache! The hospitals don't care, they make money by filling the beds regardless of severity of ailment . Everybody wants their kids to be Doctors, because they know that the money is fantastic, and all the Docs have big houses and Mercs.

The investigation is a fantastic idea, if it will be conducted! It would be interesting to see accurate figures for the mismanagement of prescription medicines just to get money. Still I guess it is no different from the UK 40 years ago, when the school dentists used to come around and they were only paid for actual treatments they did, hence most people of my generation ended up with mouths full of mercury.

Actually you are overlooking why the British have a reputation for "wonky" teeth - the free national health serivce refused to pay practitioners for what they considered "cosmetic" dentistry - so very few people were fitted with "braces" - this would have been a much bigger money spinner for dentists - in fact it is the mainstay of dentistry with young people in the States.

I wasn't overlooking the reason the British have wonky teeth. I am British have never had a brace, and don't have wonky teeth. I was talking about fillings in the back of the mouth and how school dentists were paid for the number they did, hence the comparison to Thai Doctors prescribing medicines for anything and everything. Your comment concerning braces may be accurate but is nothing to do with my post.

I'm sorry I thought you'd get it.Firstly I'm sure you've seen the film - "Spy who Shagged be" and have noticed Mike Myers teeth? - you DO realise that was intended as a joke about UK dentistry?

I'm referring to how the UK govt 40/50 years ago restricted the amount of "unnecessary" work by practitioners. i.e "cosmetic" work.

here in Thailand there is no such restriction - i fact non-dentists will fitt you with braces purely to "look good" - I find this very strange - it's a bit like wearing a plaster cast when your leg isn't broken.

The point being that in UK efforts were made to reduce the amount of fraudulent work carried out. and if you look at people around 50 to 70 years old in UK and compare them to a similar age group 50 years ago you will find that a much greater proportion of them still have their own teeth - wonky or not (how you can hold yourself up as "the norm" as an example of one out of 60 million is beyond me) their teeth are there "mercury" and all.

children in the UK were plagued with teeth problems after the war. they were bombarded with a high sugar diet and dentistry at the time did a pretty good job of retaining adult teeth right into old age - fillings were a necessary part of this as the alternative then would have been extraction. Now we have more "visually acceptable" methods, but given that in the beginning healthcare - including dentistry - was free in UK I think they did a pretty good job....wonky teeth and all

Unfortunately any attempts at free healthcare here are not only plagued by the corrupt international drug companies (Big Pharma) but also by the inherent corruption that permeates ever aspect of Thai life.so as a comparison with now in Thailand I think your example is actually pretty poor.

[Tigs]

I wasn't overlooking the reason the British have wonky teeth. I am British have never had a brace, and don't have wonky teeth. I was talking about fillings in the back of the mouth and how school dentists were paid for the number they did, hence the comparison to Thai Doctors prescribing medicines for anything and everything. Your comment concerning braces may be accurate but is nothing to do with my post.

I'm sorry I thought you'd get it.Firstly I'm sure you've seen the film - "Spy who Shagged be" and have noticed Mike Myers teeth? - you DO realise that was intended as a joke about UK dentistry?

I'm referring to how the UK govt 40/50 years ago restricted the amount of "unnecessary" work by practitioners. i.e "cosmetic" work.

here in Thailand there is no such restriction - i fact non-dentists will fitt you with braces purely to "look good" - I find this very strange - it's a bit like wearing a plaster cast when your leg isn't broken.

The point being that in UK efforts were made to reduce the amount of fraudulent work carried out. and if you look at people around 50 to 70 years old in UK and compare them to a similar age group 50 years ago you will find that a much greater proportion of them still have their own teeth - wonky or not (how you can hold yourself up as "the norm" as an example of one out of 60 million is beyond me) their teeth are there "mercury" and all.

children in the UK were plagued with teeth problems after the war. they were bombarded with a high sugar diet and dentistry at the time did a pretty good job of retaining adult teeth right into old age - fillings were a necessary part of this as the alternative then would have been extraction. Now we have more "visually acceptable" methods, but given that in the beginning healthcare - including dentistry - was free in UK I think they did a pretty good job....wonky teeth and all

Unfortunately any attempts at free healthcare here are not only plagued by the corrupt international drug companies (Big Pharma) but also by the inherent corruption that permeates ever aspect of Thai life.so as a comparison with now in Thailand I think your example is actually pretty poor.

Well that's what you get for making assumptions! No I have never seen 'The Spy who shagged me' so your attempt at hiding humour in your first statement is met with nothing but the sound of tumble weed. Sorry old chap!

Now, where on earth have I held myself as an example of the norm. Care to point that out or is that another obscure reference or line from some other movie you imagine everyone else on the planet has watched.

[tim armstrong]

The days of big pharmas offering incentives to Drs. are not quite over,especially in African and some Asian countries. But there is much more scrutiny by WHO,and a number of large international NGOs,as well as the industry itself, which has contracted significantly. The big pharmas know that there is more competition around from alternatives especially to antibiotics which increasingly are less effective.

But their big battle is to stop widely used brand name drugs from being generically produced, and therefore cheaper. Its ironic that their street front salesmen - the chemists, even in Thailand, will often try to find you a generic alternative if you ask.

I've worked with many western Drs.especially GPs who no longer accept the freebies, because it constrains their treatment options too much. But true in Thailand overprescribing rules. Interesting to read how 'sick' public servants seem to be here,as they consume/receive? a lot of medicine.

But to the old chestnut- preventative health care. Where are all the public health education programs in Thailand ? The focus is far too much on treatment and not prevention.

[Jimi007]

I was told by a doctor only a couple of weeks ago that she feared for the health of her grandchildren as after she died there would not be a doctor in the family.. She said, unprompted by myself, that most of the current crop of young doctors were well below the required standard and that all were primarily interested in money and not their patient.

I suggest that anybody who consults a doctor at a private hospital should tell them that they will only pay for remedies that treat the ailment and not those that alleviate the symptoms. Cure the problem, not the evidence in other words. Those who feel really strongly should, after taking note of the medication, refuse it and hurry off to the nearest high street pharmacy.

My experience built up over several years is that lady doctors in Thailand are more caring, appear to be more knowledgeable, are more ethical - and most of all - more honest.

Interesting view. I was referred to Phuket International Hospital by the US Embassy, who made the appointment for me, to get a checkup for my disability claim. I have a virus called chikungungya that is very painful and there is no cure. So, the only treatment is for the symptoms, pain and swelling of various joints. The fee to see the doctor and get a certified medical form, which the US Government will reimburse me for was 1,000 Baht. The 4 prescriptions were over 3,000 Baht. But some are not available at a pharmacy, like morphine. The swelling has gone down and I can walk much better, but I didn't need 2 different NSAID drugs. It was a rip off and I will only go back there in an emergency or accident as I have insurance for that. But I guess as others have said if they don't give you three or four prescriptions, they aren't making money. I guess it will look good for my disability claim that I had so many things prescribed too...

[Deeral]

To say that it is "no more" or even on the wain is flying in the face of the evidence - and WHO have little or no power over such practices especially in somewhere like Thailand. EVERY major drug company - with the possible exception of Roche has been prosecuted for criminal offences regarding their "peddling" of drugs.