Thailand's Hospital Debt Crisis Could Have Been Avoided

[webfact]

EDITORIAL

Hospital debt crisis could have been avoided

By The Nation

Our public health system is stretched because of a lack of planning; new emphasis should be on creating health providers at the village level

More than 300 state hospitals are facing a financial crisis, with total debts of more than Bt4 billion, Public Health Minister Jurin Laksanawisit told the public recently. The Health Ministry estimates that 77 state hospitals face a serious problem, with their combined debts adding up to Bt1.3 billion, while 227 other hospitals are shouldering moderate debts, worth about Bt2.7 billion in total. Most of the affected institutions are general hospitals, central hospitals and rural hospitals. There are over 900 government hospitals in Thailand.

If anything, we can be certain that this financial crisis in the public health system will definitely take its toll on management and medical services. And it goes without saying that these shortfalls are the result of a short-sighted policy. The concept of universal healthcare is a good one, but the planning has been poor. This is typical of Thailand, indeed, where elected officials do whatever they can to make a name for themselves but care little about really improving standards for the future.

The Bt30 healthcare scheme was supposed to be a service to the public, but bad planning and short-sightedness have placed the country's public hospitals in their current predicament. Voters need to think beyond what's in it for them in the immediate term. They need to look at the long-term consequences and think about how their children and their children's children will have to pick up the tab when the coffers run dry.

It's not too late to think outside the box and come up with solutions. From the look of it, too many people who can afford to pay for hospital treatment are getting a free ride. In the past there was the concept of the "health card", where the village chief or kanman played a part in determining which individuals living under his jurisdiction were entitled to this free medical scheme. But to go back to such a method to determine who is entitled to free medical care would be difficult given the movement of people in and out of cities and villages, as well as other factors such as the absence of an effective way to determine one's financial worth.

In Thailand, corporate employees are required to contribute to a social security fund that will pay off their hospital bills in times of need. Civil servants and their immediate family members are entitled to state privileges, and workers at state enterprises are entitled to similar benefits.

But the Bt30 scheme has soaked up all the money in the public health system, and something urgent has to be done to save the patient. Besides exploring the concept of cost co-sharing, the government should look for ways to prevent the over-stretching of provincial hospitals by strengthening and beefing up local health centres at the tambon and district level.

In some cases, where a local health centre is unavailable, mobile medical centres should be utilised. Moreover, educating local people on health issues, especially in remote areas, should in line with the government's idea of prevention and promotion.

One of the most visible projects that is often billed as a success story is the use of the Or Sor Mor healthcare volunteers. These volunteers are literally walking databases of information, since the patients in their villages are very well known to them. These volunteers are not certified as nurses, but they can administer first aid. It was not until this administration that these Or Sor Mor volunteers were paid Bt600 per month. Perhaps such a scheme could be an entry point to a professional health career for individuals in rural areas who are unable to afford to attend nursing or medical school otherwise.

In short, we need to think about investing in our people. Public health should not be narrowly defined as just medical services and promotion-preventive measures. It should also be about nurturing future doctors and nurses and healthcare providers, as well as empowering ordinary people so that they feel they have a stake in the system.

As of now, too many of us are too willing to take advantage of the system, as in the Bt30 universal healthcare scheme. What we don't realise is that such action comes at the expense of someone else.

-- The Nation 2011-01-18

[cloudhopper]

Bad planning? This is the inevitable result of any populist political program. Much the same is happening back in my home state of California. Expect widespread failures in both places.

[Arkady]

Since a 30Bt card was issued to me and apparently to many other farang TV members who are not Thai citizens, I have to assume there was something wrong with the criteria for issuing them.

[swillowbee]

... no! ... definately, no! ... a hospital debt crisis could NOT have been avoided.

... pick any institution in Thailand ... ANY one ... the results are predictable ... even inevitable ... I dare anyone to identify any example of exceptionism produced by any Thai institution at anytime, anywhere.

... this is Thailand ... that's just how it is here.

Edited January 18, 2011 by swillowbee

[ginjag]

Bad planning? This is the inevitable result of any populist political program. Much the same is happening back in my home state of California. Expect widespread failures in both places.

Bad planning, :lol: no. Our town hospital, is good, 3 doctors. A.E.U. service brilliant, for out patients. Bed patients near to bad, so behind the scenes cattle shed, entrance admin-doctors good. The money coming in to the department, is not all spent on healthcare for patients, The chief Admin officer, overseeing the running and finance, is a big corrupt merchant. creaming off money meant for other purposes. Example-lovely outside car ports for staff cars, gardens and flowers, beautiful modern exterior and outpatients. I should say not so much bad planning-as the watchdog suggests, if he did his job right he would know where the money is going. He only has to check hospital accounts, expences. even a random check would expose it. As allways blame the wrong people. Just to sidetrack the population. How many towns alone in Thailand-thousands ?? multiply that by per cent of money ""Missing"" result. billions in the red.

Edited January 18, 2011 by ginjag

[philhal2]

This is one of the many areas where it is a downside to the human races ability to do anything good without someone wanting to take advantage or to make a lot of money out of it .When it bcomes impossible for corporporations and individuals to control and to take advantage financially of what I see as being public domains ,ie health , water , electricity , National resources such as petroleum , gas , minerals etc then and only then will we see true humanitarian assistance and care taking place on the true worth of a nation . When the greed is stopped and the few can not steal the wealth and the resources of a Nation to satisfy their greedy lifestyles , we will not have these crisis taking place . Dont feed me the bullshit about entrepeneurs and foreign investors doing great wonders , all they do is lie , cheat and steal the wealth of countries by coercion and illegal and unethical means of getting contracts , changing laws and dealing in underhanded ways to profit unfairly from a given situation . Any nation that controls its own resources , and provides strong and ethical means of controlling corruption and theft of its National resources can afford the best of health care for its citizens .

See what is going on in all the western countries , who has all the wealth and how they got control and you will start to understand why we have had " the worlds biggest financial crisis " .

There is only debt that is created by illusion , an illusion designed to keep people stupid and downtrodden . Take control of any country politically and remove the corruption permanently , take back the National resources and ensure proper management and control and we would have Nations that can afford good health care , and be able to take care of its citizens properly .

Dont agree ?? Just do some checking and see how many individuals ( not just in Thailand ) WORLDWIDE actually have more funding and resources in their own personal wealth than any Nation . You do not get control of this type of wealth by doing things in an honest and forthright manner . you do not deserve this type of wealth no matter how you you have gained it .

There is no possible way on this planet that anyone can " EARN " huge amounts of wealth without corrupting the system , stealing , cheating , lying and corrupting others to change laws , regulations , practice deception and manipulate whole populations through corrupt laws and Governments .

Remove this and you will have funding for , Health , Power , Food , Clothing and be able to give every person the dignity of an equal oppotunity to care for their families and to live a decent standard of life .

STOP being so stupid and Naive to believe that there is any other cause for all these problems other than the greed and the control of a very small percentage of people who want to own everything and dont care how they do it .

History is proof of what has taken place and willl show you that when premiers , prime ministers , governors , presidents , kings , queens etc have been caught with their hand in the nations till ,proving special contracts to friends and family , misusing public funds etc etc , there is no prosecutions , no repayment , no punishment .

When illegal contracts have stripped millions or billions from a Nations funds who pays it back ???? NO ONE Who is punished ?? NO ONE .

Stop being so bloody naive !! there is no crisis , health or otherwise , "" due to lack of national funds or resources """ . Those funds and resources are simply being re-directed into the bank accounts and pockets of the corrupt and the dishonest who dont give a toss about anyone except themselves .

[trogers]

Money made by selling Elite cards can pay off the debts incurred by the Bt30 health care. After all, both ideas came from a single brilliant mind...

[geriatrickid]

Cut the military budget by 25% abd the shortfall will be addressed.

[SomTumTiger]

Cut the military budget by 25% abd the shortfall will be addressed.

That would take Thailand's military spending to less than 1.1 percent of the GDP. Lets allow the US to cut that deeply first, as an example to others on "the right way".

[Crushdepth]

where the village chief or kanman played a part in determining which individuals living under his jurisdiction were entitled to this free medical scheme.

Yeah I can see that working really well in Thailand. NOT.

[monkfish]

Comparing 2 health care systems in place today

1. CSMBS (Civil Servant Medical Benefit Scheme)

Covering 5 million people i.e. civil servants Budget 65 Billion Bht or 13 000 Bht per person.

2. UC (Universal health care)

Covers 47million people with a budget of 89 Billion or 1 894 Bht per person.

Why does Thailand need 2 system?

Why don't they just merge them into one?

Being the son of a doctor I would have thought Abhisits main priority would have been to improve the Universal Health Care system.

What also interesting is that government officials get private health insurance paid for!!

Not allowed to post a link to the source of the info's but it's in BP, if you google Double standards in health care you should find it.

Edited January 18, 2011 by monkfish

[asiawatcher]

Its easy enough to introduce mandatory health insurance on any worker over 50,000 Baht a month and pay a percentage towards health cover. Even if only 500 Baht a month per head - this alone covers the debt with huge surpluses but as already stated in other posts, there has to be audit to identify wasted funds in aesthetics and not going into health caress well as from corruption from officials governing budgets. Similarly tobacco taxes should be doubled as they are a huge burden on the health system by causing undue costs from people who wish to smoke and end up reliant upon health care in their latter years until their lungs finally collapse. There are dozens of solutions to this problem and none of which anyone seems to be identifying.

Edited January 18, 2011 by asiawatcher

[Orac]

Cut the military budget by 25% abd the shortfall will be addressed.

Sounds a bit much - would 2.5% not do it????

[slapout]

The author of this article probably put about the same effort as the proof readers of the newspaper which printed it. It would not be hard to imagine all of them having received their diplomas from the same 'Think Tank'

[yellow1red1]

brightest headline in ages DOH

a great, great many other things "could have been avoided" as well DUH

[yellow1red1]

Similarly tobacco taxes should be doubled as they are a huge burden on the health system by causing undue costs from people who wish to smoke and end up reliant upon health care in their latter years until their lungs finally collapse.

FYI, actuaries have shown that smokers save us all a LOT of money. They die so much younger and elder health care is biggest cost to the health systems.

non smokers last a decade longer and go through a few more major medical problems, each , than the smokers who are in the ground or cremated.

maybe an annual smoker/hero appreciation day is in order 55555

edit; on the double taxes on smokes, tho, YA ; booze too, legalise pot,,, triple tax yaaa

Edited January 18, 2011 by yellow1red1

[warfie]

Blimps are more important than hospitals and schools...

[fredtitmus]

I can kill two birds with one stone here,there is a major problem on the roads with accidents(as shown on another post) which must cost the hospitals millions per year,especially when guys are going in with serious head injuries resuting from not wearing a crash helmet on a motorbike.I say get some hard hitting advertisements on tv about awareness and what happens to loved ones when speeding,not wearing a helmet and drink driving on the roads.Also clamp down on the guys not wearing crash helmets,if you get stopped the 1st time it is 500bt the second time is a 6 month ban and 2000bt fine,just doing these 2 things alone would save the hospitals, make the roads a little safer and the people more aware.