Free Treatment In Thailand, But Where Is The Medical Staff?

[webfact]

EDITORIAL

Free treatment, but where is the medical staff?

By The Nation

Populist health schemes sound good but cannot work unless the government helps to provide enough doctors and nurses to run them

During this election campaign, politicians have promised voters free or virtually free medical services. However, they are missing the point, as the real issue facing Thai public health is not the cost of service but whether we have sufficient personnel to care for those in need.

The Democrat Party has promised voters it will increase the universal healthcare budget to Bt130 billion per year, while the Pheu Thai Party says it will continue the Bt30 universal healthcare scheme initiated by its predecessor Thai Rak Thai Party.

Some politicians may argue that the public wants the populist approach offered by all the political parties. But the parties still do not understand that all governments have failed to address the root causes of the public health problems.

Regardless of how excellent a healthcare programme is on paper, the public will not be able to benefit from it if there are insufficient health personnel.

Any government can claim that it will provide free medical treatment. But this will be useless if hospitals, especially those in the provinces, are desperately short of physicians and nurses.

The understaffing situation at some public hospitals has become worse partly because of the government's extended healthcare programme, which puts more pressure on public hospitals, which are already short on government-provided resources.

Many physicians have left the public hospitals in remote provinces to work in private hospitals in Bangkok and other big cities where they have less work load, better support facilities and more equipment to perform their duties.

The shortage of staff is seen in recent statistics from Medical Council records. It shows that 39,395 doctors are practising around the country, but at least 9,772 more are needed to fully serve the public health system. Dr Chanvej Satthabhud, president of the Trauma Association of Thailand, was recently quoted as saying that there was a critical need for extra physicians to perform emergency treatment for accident victims.

He added that the Medical Council's records also show that we have only 300 emergency surgeons and neurological surgeons working at hospitals across the country, and only 50 of these are now working at rural hospitals nationwide.

The situation in the nursing profession is no better. Thailand needs 180,435 nurses to provide adequate coverage, but the Kingdom now has only 130,710. Again, the shortage is more serious in rural provinces.

The ongoing social division is a result of inequity in our society. Many people feel they have been unfairly treated in a variety of ways. They feel they have been denied access to public services and education opportunities. People in the countryside certainly don't have fair access to quality schools, hospitals and clinics.

These are the issues that the new government must tackle. But so far the candidates have focused instead on populist economic approaches. Promises of free medical treatment are fine, but the quality of such a service is very much in question.

The other issue that politicians conveniently forget is that better public health can be achieved through prevention. A proper public healthcare policy needs to work from both sides: prevention and treatment.

The most effective way to promote good public health is to ensure that the public is educated and encouraged to be mindful of their health. A substantial effort should be placed on how to teach people to stay healthy by eating vegetables and fruits. Thailand is already beginning to face the serious obesity problem that has afflicted developed nations for decades.

-- The Nation 2011-06-18

[JohannaScott]

The 30 baht scheme sounds fine until you find that you need medical services outside your own province. Then it doesn't work. Doctors and Nurses will go where the pay is better too.

[Ricardo]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

Surely this basic-healthcare benefits the poor most, and re-introducing TRT's original charge would only hit the poor, are they that desperate to avoid admitting that it was a good thing, when a later government abandoned the expensive-to-collect charges ?

[OlafStapleton]

Not every region the same.

Chiang Mai province and many others are still 30bht system.

[noahvail]

The 30 baht scheme sounds fine until you find that you need medical services outside your own province. Then it doesn't work. Doctors and Nurses will go where the pay is better too.

Actually, it does work. All you need is authorization from a doctor in your province. I get authorization to see a specialist out-of-province. The specialist's hospital bills back to my province.

[DiamondKing]

The 30 baht scheme sounds fine until you find that you need medical services outside your own province. Then it doesn't work. Doctors and Nurses will go where the pay is better too.

Actually, it does work. All you need is authorization from a doctor in your province. I get authorization to see a specialist out-of-province. The specialist's hospital bills back to my province.

Can someone explain exactly how this 30 baht system works I cant seem to get a straight anwer out of the missus

Dk

[Phil Conners]

Yes I'd like to know that as well. My wife was recently quoted around 2,000 baht for a full medical checkup at Banglamung Hospital in Pattaya.

[OZEMADE]

My Thai Father in Law had a stroke and has sugar diabetes. He pays Bt30 for a visit to the Doctor at the public hospital. He does however have to pay Bt2000 for his heart tablets and his insulin and needles. This is for 3 months supply. He also had a visit to the Thai Public Dentist at the hospital, Bt30. He was told due to his poor health he had to have all his teeth out and false one made and fitted. He had this done. Bt5000. All very cheap.

This was at the Lop Buri Public Hospital.

I cut my foot and went to the hospital, had stitches and stayed overnight. Bt9000. Thats the difference.

[PEP]

Yep, the scheme is there B30 to see the hospital Doc. Go early as by 900am some hundred waiting. Initial screening by nurse then one shuffles along the queue to Consultation, Diagnose and Prescribe. TWO MINUTES ALLOCATED PER PATIENT. Not through by 4.00pm. "see you tomorrow".

Medical Care? Some joke for the poor Thais who leave without being given a diagnosis, clutching a bag of pills which seeming are always the same ones prescribed regardless of whether one has "Pox, Piles or Pimples"

[WinnieTheKhwai]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

Surely this basic-healthcare benefits the poor most, and re-introducing TRT's original charge would only hit the poor, are they that desperate to avoid admitting that it was a good thing, when a later government abandoned the expensive-to-collect charges ?

You need a nominal charge as a (slight) deterrent to people who would go there just for some free paracetamol when they get a cold.

Sometimes I am tempted too to get some free meds under social insurance and not from a pharmacy. I bet poor people are even more tempted.

[citizen33]

Yes I'd like to know that as well. My wife was recently quoted around 2,000 baht for a full medical checkup at Banglamung Hospital in Pattaya.

The article is confused and confusing. The 30 baht project was from its early days also known as the universal coverage scheme (UCS) or gold card scheme. The three major parties all support the scheme and PTP has no plans to reintroduce a 30 baht co-payment (which was discontinued because the administrative cost of collection limited any gains made). The UCS has been free since 2006, so the use of the word 'promise' seems inappropriate. Admittedly, the workforce issue is a real one and there are big cost pressures within the system. On the other hand the additional cost of running the UCS compared with the previous partial schemes is quite low, and Thailand has been widely praised by international health policy experts for the move to universal coverage. More work undoubtedly needs to be done to address doctor/nurse training and retention in the public system, and solutions are not going to be straightforward. There are various incentives and strings attached to training to keep professionals in rural areas, but many do still leave. Recently some rural provinces are funding university nursing studentships for local people, with a requirement to stay and work in the area. As I think everybody knows, there are also quality problems with the UCS, and reports of various forms of rule bending or corruption by local doctors.

Despite all of this, many of us believe that the UCS (and the public social security and civil servant schemes) are more attractive than the alternatives. Thailand has never had a large private medical insurance sector, largely because most of the population could not afford the premiums (PMI accounts for only about 6% of health spending). Additionally, some experts complain that Thai PMI has one of the lowest 'loss ratios' of major nations (i.e. takes more out in profit than schemes in most other countries). There is a lot of out-of-pocket spending on private healthcare, but probably much of this is for cheaper routine treatments. One big plus of the UCS documented in research is that it has protected people across Thai society from the consequences of catastropic health expenditure.

Studies have shown that the UCS is popular among middle and lower income Thais. Through the 1990s the Democratic Party and other parties of the time frustrated the aspirations of a group of progressive reformers within the MoPH, saying that UC was not affordable in a lower middle income country. That all changed after 2001. A party adopting the policy hinted at in the OP article would likely pay a high electoral price, and that has been reflected in the recent policies of all major parties.

A move back to the old system would further increase class-based health inequalities, and might not be in the best interests of a nation which is trying to make the transition to a modern manufacturing economy. Historically improved healthcare has supported capitalism rather than undermining it.

Some details of the UCS are here:

http://jointlearningnetwork.org/content/universal-coverage-scheme

http://jlw.drupalgardens.com/sites/jlw.drupalgardens.com/files/Thailand%20presentation%20for%20provider%20managment.pdf

Edited June 18, 2011 by citizen33

[samurai]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

[noahvail]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

It's "universal health care" - not "free." It's free to see a GP in the local hospital. Labs are extra - a full bloodwork recently cost 800 baht. Seeing a specialist costs 50 baht. Meds on the government "approved" list are free - but they are very basic meds. My meds cost between 9,600 and 12,000 baht per month at the hospital; because they're not on the "approved" list, they're not free. They are only marginally cheaper at the local hospital as opposed to a pharmacy, and they are available. The med cost is about half of what I would pay in New Zealand, though.

Expensive for the average Thai? Absolutely. But compared to the private hospitals, it's very inexpensive. And, unlike the private hospitals, they will let patients go home even if they can't pay.

Last year in a nearby village, an elderly and very poor lady was hit in the head with a machete. It broke through the skull. She was transferred to the provincial hospital, where a neurosurgeon was brought in to operate. It took her three weeks before she could go home, and 6 months of therapy, but she's fine now. She was not charged for the services. The system can and does work. It's not perfect by a long shot, but it does help.

[ginjag]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

The 30 bht scheme, that Thaksin brought in ?? I,m in red shirt country and for the last 2 years the democrats in this area wavered the fee, to help the poor, So I suppose it's bad to help now is it ???

All this post is offering is a discussion on shortages. NOT Remedies. The biggest problem by far is the prevention of people having to attend hospitals. Traffic incidents==food poisoning==alcohol abuse and it's affects==disease prevention (cleanliness at home-care) amongst others.

Police traffic laws strictly to be enforced--health authorities to check on the food outlets that Thai people buy from (local markets) our town markets are disgusting. Stop the sale of high alcohol local brews--or put a terrific tax on it. Locally near everywhere you go you will observe a bottle of Laos whiskey under a large bamboo table.

Before the 30 bht scheme the hypochondriacs didn't stay away !!! So many people are going to hospital for some para, eno's, or even for boredom. But bottom line is prevention, save money--and save recruiting all these extra staff-or a half of them.

[boggle]

GF had emergency appendectomy. BKK.

5 days hospital. 240 Bht. Not the best I admit. But..............

BTW. she had full BUPA coverage at the time.

TIT.

[citizen33]

There is a lot of misinformation in some of the above posts. The 30 baht co-payment was abolished shortly after the coup and has not been 'waived' by the Democrats. Nor in theory should there be extra charges unless patients want drugs, tests or appliances not covered by the scheme - there is no 50 baht specialist charge. As I mentioned, some doctors do not obey the rules but that is not about the provisions of the scheme.

Prevention is a key element of the UC scheme - as seen in the catchphrase 'sarng-nam-sorm' (build before cure). But it has been a problem to get some of the rural doctors to let the money flow to the health centres for promotion and prevention activities.

Could I respectfully suggest that people who want to know about this topic do some reading?

http://www.nhso.go.th/eng/index_main.jsp

http://www.hsri.or.th/en

http://www.hisro.or.th/main/index.php?name=research

http://ihpp.thaigov.net/

http://www.tdri.or.th/th/php/

You will need to go to the publications sections of these websites where you will find references to some English language reports.

Anecdotes from one's mate in the bar are no substitute for looking at the evidence. And 'yes' I have been out in the 'field'.

Edited June 18, 2011 by citizen33

[noahvail]

There is a lot of misinformation in some of the above posts. The 30 baht co-payment was abolished shortly after the coup and has not been 'waived' by the Democrats. Nor in theory should there be extra charges unless patients want drugs, tests or appliances not covered by the scheme - there is no 50 baht specialist charge. As I mentioned, some doctors do not obey the rules but that is not about the provisions of the scheme.

Prevention is a key element of the UC scheme - as seen in the catchphrase 'sarng-nam-sorm' (build before cure). But it has been a problem to get some of the rural doctors to let the money flow to the health centres for promotion and prevention activities.

Could I respectfully suggest that people who want to know about this topic do some reading?

http://www.nhso.go.t.../index_main.jsp

http://www.hsri.or.th/en

http://www.hisro.or....p?name=research

http://ihpp.thaigov.net/

http://www.tdri.or.th/th/php/

You will need to go to the publications sections of these websites where you will find references to some English language reports.

Anecdotes from one's mate in the bar are no substitute for looking at the evidence. And 'yes' I have been out in the 'field'.

My posts are from my personal experience in government hospitals, not from anyone else. I have kept the receipts with the specialist charge of 50 baht itemized.

Obviously, your experience "out in the 'field'" differs from mine. But I'm not going to complain about paying 50 baht for a well-qualified specialist who charges 800 baht at a private hospital for the same service.

[Ricardo]

Reading through the thread, there seems to me to be general-agreement on all sides that the service needs to be improved, does anybody have any view on what needs improving first & how this might be paid for ?

Would more local-clinics help deliver better basic-service in the villages, or a national not-for-profit ambulance-service be a priority ?

[roamer]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

The 30 bht scheme, that Thaksin brought in ?? I,m in red shirt country and for the last 2 years the democrats in this area wavered the fee, to help the poor, So I suppose it's bad to help now is it ???

All this post is offering is a discussion on shortages. NOT Remedies. The biggest problem by far is the prevention of people having to attend hospitals. Traffic incidents==food poisoning==alcohol abuse and it's affects==disease prevention (cleanliness at home-care) amongst others.

Police traffic laws strictly to be enforced--health authorities to check on the food outlets that Thai people buy from (local markets) our town markets are disgusting. Stop the sale of high alcohol local brews--or put a terrific tax on it. Locally near everywhere you go you will observe a bottle of Laos whiskey under a large bamboo table.

Before the 30 bht scheme the hypochondriacs didn't stay away !!! So many people are going to hospital for some para, eno's, or even for boredom. But bottom line is prevention, save money--and save recruiting all these extra staff-or a half of them.

Good post. Hard to think of a health system anywhere that could sail serenely on through the troubled waters that Thailand repeatedly fails to deal with. Imagine for just one moment a motorcycle helmet law rigorously applied, overnight the shortage of neurosurgeons would disappear.

[citizen33]

Reading through the thread, there seems to me to be general-agreement on all sides that the service needs to be improved, does anybody have any view on what needs improving first & how this might be paid for ?

Would more local-clinics help deliver better basic-service in the villages, or a national not-for-profit ambulance-service be a priority ?

The current thinking is that incremental improvement in several areas is needed. For example:

1. Under the provisions of the Decentralisation Act 1999 an increasing proportion of health funding needs to be channeled through local government, and there is a perception that this could give local communities a bigger voice. Two develeopments currently being rolled out in many areas are (a) local health funds overseen by communitty committees and mainly disbursing monies for 'prevention and promotion' activities and (b ) tambon health promotion hospitals which have joint local government and MoPH funding, and comine promotion with basic treatments.

2. The need to counter recruitment problems in primary care units (clusters of health centres) by re-attaching these more closely to community hospitals (which have doctors) and renaming them as community medical units (CMUs).

3. Tightening up the administration of local health care systems by introducing 'new public management' type tools like KPIs, benchmarking, eBilling and performance-based incentive payments, overseen by the Provincial Health Offices (saw-saw-jaw) and Regional offices of the NHSO. This is seen as a way of using existing resources more efficiently and improving governance.

4. Improving the incentives for doctors to remain in rural areas. Present measures include accelerated promotion through the civil service grades for doctors in rural community hospitals plus bonus payments, but this is still much less than can be earned in private hospital work (even though many also have private office practices as well). Some provincial health offices are hiving off some of the UC budget to pay for training for local students (mainly nursing courses) with the expectation that they will stay in their home area after qualification.

5. Move towards harmonising the three public scheme so that benefit packages are more similar and any status differences between the schemes are reduced.

6. Continue with efforts to shift more resources towards rural areas in distant provinces and away from teh concentration of large hospitals in central region.

6. Use money from an hypothecated 'sin tax' to part fund health care.

6. Consider further limitations on provision of non-essential drugs.

7. Liaise with the Ministry of Health, Republic of Korea to compare UC experiences and learn lessons from each other

There is no great enthusiasm for privatising the public schemes but there are worries about the sustainablility of the current financing models, given that expenditure on the 3 public schemes is expected to double in the next 7 years

If you look at the slide shows here you'll see the kinds of issues that are discussed.

http://www.princemahidolaward.org/pmaf-conferences.en.php

Going back to the poster above who paid 50 baht for a consultation: his account suggests that he paid for his own treatment outside the UCS. He is referring to the reasonable fees charged by MoPH hospitals when they treat Westerners. My experience of the workings of the UCS is in a professional capacity, though I accept that others may know more.

Edited June 18, 2011 by citizen33

[ginjag]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

The 30 bht scheme, that Thaksin brought in ?? I,m in red shirt country and for the last 2 years the democrats in this area wavered the fee, to help the poor, So I suppose it's bad to help now is it ???

All this post is offering is a discussion on shortages. NOT Remedies. The biggest problem by far is the prevention of people having to attend hospitals. Traffic incidents==food poisoning==alcohol abuse and it's affects==disease prevention (cleanliness at home-care) amongst others.

Police traffic laws strictly to be enforced--health authorities to check on the food outlets that Thai people buy from (local markets) our town markets are disgusting. Stop the sale of high alcohol local brews--or put a terrific tax on it. Locally near everywhere you go you will observe a bottle of Laos whiskey under a large bamboo table.

Before the 30 bht scheme the hypochondriacs didn't stay away !!! So many people are going to hospital for some para, eno's, or even for boredom. But bottom line is prevention, save money--and save recruiting all these extra staff-or a half of them.

Good post. Hard to think of a health system anywhere that could sail serenely on through the troubled waters that Thailand repeatedly fails to deal with. Imagine for just one moment a motorcycle helmet law rigorously applied, overnight the shortage of neurosurgeons would disappear.

Nice to have someone respond and agree, I was beginning to think my Idea was wrong, as all the rest are posting extra long remedies about recruiting etc., and no one seems to think 50% of staff and time are for VERY preventable things.

Back in U.K. through a local doctor. your referred on to the hospital. Here the village people by-pass the village clinic and most turn up at the outpatients department-town hospital. What's the point of having a local medical (Tambon)( head village) clinic, here they are equipped with paracetamol and pain killing injections.

Sometimes the most simple remedies give the answers. Prevention -posters--PREVENTION

[Ricardo]

Citizen, many thanks for an interesting response there. :jap:

[OlafStapleton]

There is a lot of misinformation in some of the above posts. The 30 baht co-payment was abolished shortly after the coup and has not been 'waived' by the Democrats. Nor in theory should there be extra charges unless patients want drugs, tests or appliances not covered by the scheme - there is no 50 baht specialist charge. As I mentioned, some doctors do not obey the rules but that is not about the provisions of the scheme.

Prevention is a key element of the UC scheme - as seen in the catchphrase 'sarng-nam-sorm' (build before cure). But it has been a problem to get some of the rural doctors to let the money flow to the health centres for promotion and prevention activities.

Could I respectfully suggest that people who want to know about this topic do some reading?

http://www.nhso.go.t.../index_main.jsp

http://www.hsri.or.th/en

http://www.hisro.or....p?name=research

http://ihpp.thaigov.net/

http://www.tdri.or.th/th/php/

You will need to go to the publications sections of these websites where you will find references to some English language reports.

Anecdotes from one's mate in the bar are no substitute for looking at the evidence. And 'yes' I have been out in the 'field'.

The government hospitals in Chiang Mai are still collecting 30bht per visit from Thais.

I know, I pay.

[evanson]

I stopped reading after the words 'politicians' and 'promised'.

[anterian]

A few years back (the year of the tsunami), I visited a private hospital in Bangkok. I saw a doctor, had an abdominal ultrasound scan, then saw a specialist. I was not worried about the bill I assumed my travel insurance would cover it. Unfortunately it did not because it was less than 50 Pounds, in fact it cost 16 pounds.

Last year I had a small filling in a tooth done in England, it cost 46 pounds under the National Health scheme. It fell out a month later. I had a new filling in Thailand it cost 300 Baht about 6 Pounds.

My gf was getting free monthly medication from a BKK hospital, then she mentioned she was living with a Farang, she now has to pay 500 Baht per month. She has now been told that if she gets a certificate from the local Pooyai that she is self supporting she can go back to paying nothing.

A neighbour broke his foot a few days ago in a motor accident, he had to pay for the ambulance and surgery but not the medication.

There is probably a logic in all this, but I'm not sure what

[ginjag]

Citizen, many thanks for an interesting response there. :jap:

Could agree with all the good info offered, health services all over the world have tried these remedies, most modern countries are struggling.

Thailand is not unique as some other Asian countries suffer from what I posted==Prevention,,, getting my head round all the tried and tested methods --I find difficult, If you think that your formula would help (Citizen) good but looking at my Idea-Think how much less staff would be needed-nurses to surgeons- if the laws were enforced thats for starters, we don't have to look up stats from google or big modern countries ideas, we should be going for the jugular

If the health care was in my hands,(( I wouldn't be looking for another tens of thousands of staff--NO WAY-but it's an easy way out if it is government money)).The west have the best brains-they think-in the world, look at the admin-ridiculous, and they can't manage.

[bkk_mike]

Absolutely correct that the healthcare-system needs to be funded properly, and that was never properly addressed by anyone, but why do PTP want "to continue the Bt30 universal healthcare scheme", rather than accept that it's now free and should continue to be free ?

It is not free. People who actually live in Thailand and talk with the Thai people will know that. That *universal free health care* are just some good sounding words of a Democrats policy, but it doesn't exist in reality.

Read the other posts here.

And the 30 Baht can keep some hypochondriacs away. It makes sense.

The 30 bht scheme, that Thaksin brought in ?? I,m in red shirt country and for the last 2 years the democrats in this area wavered the fee, to help the poor, So I suppose it's bad to help now is it ???

All this post is offering is a discussion on shortages. NOT Remedies. The biggest problem by far is the prevention of people having to attend hospitals. Traffic incidents==food poisoning==alcohol abuse and it's affects==disease prevention (cleanliness at home-care) amongst others.

Police traffic laws strictly to be enforced--health authorities to check on the food outlets that Thai people buy from (local markets) our town markets are disgusting. Stop the sale of high alcohol local brews--or put a terrific tax on it. Locally near everywhere you go you will observe a bottle of Laos whiskey under a large bamboo table.

Before the 30 bht scheme the hypochondriacs didn't stay away !!! So many people are going to hospital for some para, eno's, or even for boredom. But bottom line is prevention, save money--and save recruiting all these extra staff-or a half of them.

Good post. Hard to think of a health system anywhere that could sail serenely on through the troubled waters that Thailand repeatedly fails to deal with. Imagine for just one moment a motorcycle helmet law rigorously applied, overnight the shortage of neurosurgeons would disappear.

But, at the same time, if the motorcyclists wore proper helmets, where would the transplant surgeons get donor organs from?

I honestly believe that people should be allowed to drive without a helmet if they want, so long as they have "organ donor - do not resuscitate" tattooed somewhere that ambulance staff would see it, or on an armband, etc. Evolution at it's most basic.

As for the 30 baht scheme. It's maybe not perfect, but it's a lot better than what came before it. I know one 70yo widow who got a pacemaker fitted under the scheme. (and if you truly have no money, it's probably better than the States where people end up declaring bankrupcy because they can't pay their medical bill after an unexpected major surgery).

Edited June 18, 2011 by bkk_mike

[Thongkorn]

Most Thai people know which hospital to use if they need treatment, Because some Hospitals want money or guarantees before treatment , This is why the NHS in The UK is the envy of the world, but its being mistreated and abused by health tourists. The same goes for Thailand ,people are abusing it making it difficult for the poor Thai people to get health care.

[evanson]

I honestly believe that people should be allowed to drive without a helmet if they want, so long as they have "organ donor - do not resuscitate" tattooed somewhere that ambulance staff would see it, or on an armband, etc. Evolution at it's most basic.

[unquote]

Are you sane?! Did you once have an accident causing you to lose any mental faculties/empathy you may once have had? Are you a fan of 'Soylent Green' too? Dear God!

Edited June 18, 2011 by evanson

[Nisa]

My understand was the 30-baht fee was done away with because it cost a lot more than 30-baht to collect, record and account for each 30-baht collection. In other words it was significantly cheaper for the government to have no fee instead of a minuscule 30-baht fee.