World Urged To Follow Thai Healthcare Model

[webfact]

World urged to follow Thai model

THE NATION

WHO calls for focus on preventing disease, promoting healthy behaviour

Inspired by Thailand's successful universal healthcare scheme, the World Health Organisation (WHO) is planning to encourage a similar model worldwide.

"We will highlight the fact that this scheme is a form of investment for the country's economic and social development at international meetings where decision-makers from various countries gather," Dr Maureen E Birmingham yesterday said in his capacity as the WHO representative to Thailand yesterday.

He was speaking at a forum held at the Centara Grand at CentralWorld as part of the Prince Mahidol Award 2011 events.

Birmingham said WHO would also work with its allies in government, civic and academic sectors to push for the launch of universal healthcare scheme in various different countries.

THAI HEALTH SCHEME INSPIRING

Dr Timothy G Evans from the BRAC University's School of Public Health said research on the implementation of the decade-old universal healthcare scheme found that the scheme covered up to 75 per cent of Thai population.

"Thanks to the scheme, the rate of bankruptcy relating to medical bills has dropped from 6.8 per cent in 1995 to just 2.8 per cent in 2008," he pointed out.

He said the scheme had prevented more than 80,000 families in Thailand from getting poorer.

"The satisfaction level in the scheme has also increased significantly," Evans said.

In 2004, medical workers and medical-service providers gave the scheme just 39 out of the possible 100 points. However, in 2010, they gave the scheme up to 79. People, meanwhile, gave the scheme 83 points in 2003 and as many as 90 points in 2008.

Evans said Thailand launched the universal healthcare scheme at a time when its national income was just US$1,900 (Bt60,000) per head. To him, the successful implementation of the scheme has proven to the world that a country did not need to be rich before it could come up with such healthcare coverage for its people.

SOME PROBLEMS STILL PRESENT

Health Insurance System Research Office director Dr Samrit Srithamrongsawat, however, suggested that Thailand would still need to tackle problems in its healthcare systems.

One of them, he said, was the fair distribution of resources.

Health Systems Research Institute director Dr Pongpisut Jongudomsuk said there was still inequality among people receiving healthcare services under different types of healthcare schemes.

Evans said Thailand's universal healthcare scheme would have to adjust itself well to the changing context, too.

"Thailand will have more elderly citizens in the future and their health needs will be different from the young," he said.

Birmingham said in its second decade, the universal healthcare scheme in Thaiand should focus more on the prevention of disease and the promotion of good health.

"The scheme should seriously encourage people to avoid unhealthy behaviour," he said.

He believed that Thailand's universal healthcare scheme should extend its coverage to migrant workers, too.

The number of these migrant workers is between 2 million and 4 million.

Birmingham said these migrant workers were resources for Thailand's economy and society. Medical services for them, he added, would bolster Thailand's health security.

-- The Nation 2012-01-25

[carbine1125]

Now if they could only find a way to pay the doctors and nurses salary.........

[dsprtliving]

Now if they could only find a way to pay the doctors and nurses salary.........

Exactly!!! My partner is a respiratory physician working at a government hospital and sometimes has to go months without receiving his salary on time, which is already far less than a manager at McDonald's. He and several of his colleagues would have left this "exemplary model" already if they weren't tied down for years by predatory government contracts.

[mrtoad]

Now if they could only find a way to pay the doctors and nurses salary.........

When all those kick backs have to be paid, it's always the ones that do the real work who get shafted.

[Joeb]

I don't doubt for a minute that for many people the healthcare system is better than what they had access to before but it is far from a shining example of how healthcare should be run. Gross overcrowding, over worked underpaid staff, unsanitary conditions. I have watched two in-laws die in government hospitals. The nurses and doctors were trying. I talked to several. They simply cannot cover the number of patients they have. My mother in law died in an 8 bed ward which had up to 16 people in it at a time, and that doesn't count the masses of family who hang around constantly. It was a very depressing place to go.

The father in law, at 70, went in with severe abdominal pain and the family was told, without any tests being run, that he probably had cancer. Because he was old they did not have the resources to care for him and that he should go home and die. Took him to a private hospital where they found a bladder infection that was cleared up in a week. He lived another 7 years.

I carry more medical insurance than I can really afford just to make sure I never have to go into one of those hospitals.

[n1sse]

My girlfriend is a nurce at a rural goverment hospital. She likes the work but now she wants to make a duck farm, we talked whit here friend who already hava duck farm and started calculating... working about 2 hours a day taking care of the ducks she would dubble here sallary compared to working 8 hours 5 days a week at the hospital + owertime.

[saengsureeya]

http://www.thaivisa.com/forum/topic/528360-thai-healthcare-system-deteriorating-academics-warn/

[alant]

how was this conclusion arrived at, so many of my wife's elderly relatives have been simply told cant be done at your age when they needed treatment

[jaltsc]

"Dr Timothy G Evans from the BRAC University's School of Public Health said research on the implementation of the decade-old universal healthcare scheme found that the scheme covered up to 75 per cent of Thai population."

Yes, the costs are covered by this scheme...BUT...that says nothing about the qualty of care. A few months ago, a Thai friend went into the local hospital and did not receive her prescribed medication for 3 days. However, on the third day the mistake was discovered and she was given all three days' medication at once. Unfortunately, she did not survive.

A friend's sister recently went into the same hospital with vaginal bleeding. She was examined, released and told that all she needed was some rest. Two days later she was severely hemorrhaging found to be caused as a result of a miscarriage which caused the initial bleeding. She returned to the hospital and barely survived after follow up treatment. Not to worry, the scheme covered all costs. Unfortuately, I don't think her funeral costs would have been covered if she had not survived the botched up service.

However, if both were farang, they would have received the same service, but in a nicer room and the bill would have been around 80,000 THB.

Yes, thiese are good reasons that the world should follow the Thai model of healthcare

[Pib]

The universal health care program is definitely a good thing for the Thai population as it provides medical care for tens of millions which had no medical coverage before the program came along. It's probably the one good thing that Thaksin implemented when he was PM. Before the universal health care program many people would or could not visit a hospital for care because they simply did not have the money...people would just stay home instead...and unfortunately sometimes, die at home for simple medical problems that got out of control. While maybe the program could be a model for other 3d world/emerging nations it's a model with flaws such as inadequate medical facilities/equipment, overworked & untrained medical staff, underfunding, etc. But in closing, overall, it's a very good thing for the Thai people, especially for poor Thais, compared to what they had before (i.e., no affordable medical coverage).

[kannon99]

WHO says that C-section rates should be no more than 10-15%, even in high risk moms. Thailand's rates are usually around 70-90+%.

WHO says that babies should be exclusively breastfed for the first 6 months of life. Thailand's rates are a little over 5%, and a little over 1% for Bangkok.

Not a healthcare system that I would care to be in. And that's just the field of medicine that I am very familiar with. Who knows about all the other medical fields out there.

[Pib]

"Dr Timothy G Evans from the BRAC University's School of Public Health said research on the implementation of the decade-old universal healthcare scheme found that the scheme covered up to 75 per cent of Thai population."

Yes, the costs are covered by this scheme...BUT...that says nothing about the quality of care. A few months ago, a Thai friend went into the local hospital and did not receive her prescribed medication for 3 days. However, on the third day the mistake was discovered and she was given all three days' medication at once. Unfortunately, she did not survive.

A friend's sister recently went into the same hospital with vaginal bleeding. She was examined, released and told that all she needed was some rest. Two days later she was severely hemorrhaging found to be caused as a result of a miscarriage which caused the initial bleeding. She returned to the hospital and barely survived after follow up treatment. Not to worry, the scheme covered all costs. Unfortunately, I don't think her funeral costs would have been covered if she had not survived the botched up service.

However, if both were farang, they would have received the same service, but in a nicer room and the bill would have been around 80,000 THB.

Yes, thiese are good reasons that the world should follow the Thai model of healthcare

The quality of care can also be very good. A little over a year ago my almost 80 year old Thai mother-in-law had major back/spine surgery in a provincial hospital...she was in the hospital for 14 days. A few days after checking and a day before the surgery she was taken by ambulance to have a lower back MRI done in Bangkok...the ambulance crew was driver and a nurse...and of course she was taken back in the same ambulance. The next evening she underwent the 4 hour surgery. Care by the hospital staff during her stay was just fine and the follow-on care via several hospital visits for checkup was fine...along with all the free medications she was issued...the abulance trip to-and-from Bangkok was free also. Her total cost for the surgery, hospital stay, medications, etc., would have been "zero" except we decided to have her stay in a private room versus a ward during her 14 days stay...for this room we paid 600 baht a day for a total of 8,400 baht...all other costs were covered by the universal health care program.

Edited January 25, 2012 by Pib

[arrowsdawdle]

In the slightly adultereated lyrics of Johnny Cash: Bill, or Bob, or John....anything but Sue Maureen.

[khunPer]

May be different from area to area? I have only good experience with public Thai hospitals. We used one in the Surin area when my GF gave birth by caesarian - she wished to use the hospital she know at her home town - and I was impressed, coming from a Scandinavian country, claiming to be among the best health care systems in the World. Especially the human care of patients, impressed me. We could afford a socalled VIP-room with en-suite, aircon, TV and guestbed; 150 baht extra a day. As my GF were moving into the Social Security scheme, but had not recieved her (blue) card, we had to pay for the service - she could claim the money back from the Amphor, when she got the card by mail - three days at hospital, operation and everything ended up around 11,000 baht. However we never claimed the money back, as I was happy to pay that rate for the service.

I had a friend using the public hospital at Samui for a small cosmetic operation, he never had time to make in his Scandinavian home country. He was very happy with the service and was charged 1100 baht only. I also have Thai friends using the free public hospitals and I always had a good impression from my visits.

So may well be, that some districts provide better hospital service than others?

Edited January 25, 2012 by khunPer

[chainarong]

Yeah, right ,it's April the first , he he he.

[BigJohnnyBKK]

Obviously not all part of the world can afford the high levels of medical care those in the developed parts have come to expect.

As an American I have absolutely no doubt that the US would have a lot to learn from Thailand in this area, as our health care system is absolutely criminal in its catering almost solely to our elites and almost complete abandonment of those most in need. The key challenge in any country is making a very minimum basic level as freely and fairly available to as many people as possible.

The fundamental problem is the focus on gee-whiz tech lets-see-whats-possible, as opposed to ensuring ordinary but critical cost-effective measures are available for all. Unfortunately such a shift means denying the most expensive solutions to the publicly supported, if the rich want to take advantage of them they their private insurance can pay for it.

In a poor country, or one where the population doesn't want the poor to be "too subsidized", what many Westerners would consider basic care needs to be denied to many.

The issue of pay for people in the medical profession is way off the charts on both ends - the US on one side, where becoming a doctor is assumed to be a guaranteed gravy train to IMO a criminal extent, and Thailand, where it is impossible for them to live on their normal salaries, and working for a hospital is basically volunteering in exchange for access to patients to promote your private after-hours services where you make your living.

I don't think anyone claims that Thailand has the whole conundrum solved, but if WHO states that it's macro-level organisational scheme is a good example for other less-developed countries to follow, I heartily congratulate this wonderful country and share in its pride for this important recognition.

[BigJohnnyBKK]

WHO says that C-section rates should be no more than 10-15%, even in high risk moms. Thailand's rates are usually around 70-90+%.

WHO says that babies should be exclusively breastfed for the first 6 months of life. Thailand's rates are a little over 5%, and a little over 1% for Bangkok.

Not a healthcare system that I would care to be in. And that's just the field of medicine that I am very familiar with. Who knows about all the other medical fields out there.

My first wife, an Australian trained nurse, was a rabid supporter of natural home birth and long-term breastfeeding, and was constantly scoffed at and berated by her fellow medical professionals. Now her views have been proven largely correct by scientific evidence, but it took a long time for the mainstream to come around.

These IMO just as much symptoms of social/cultural issues and failings of education rather than the healthcare system, and relatively minor issues for a developing nation.

[ma91c1an]

My mother-in-law died of cancer at home after a few weeks of perfunctory treatment in a government hospital near the Victory Monument.

They had no funds to provide her with effective pain killers, and she was in great pain as she declined. My best friend, on the other hand, a foreigner with sufficient assets, was hospitalized at Bangkok Hospital while he faded way with cancer. He had IV Demerol as needed for pain. He had battled the malady for two years through a combination of chemotherapy and surgeries.

Grandma's treatment at the government hospital was nightmarish. It was packed with desperately ill people patiently waiting for charity. The nurses and the doctors did their best with what they had, but they often lacked basic medical supplies. At times, their patience ran low. I can only imagine their frustration and their feeling of helplessness, particularly knowing that they could have done more with better funding.

The only reason that Thailand's current health scheme is "good" is because it exists, whereby previously there was nothing in its place. The ill simply stayed home, as an earlier poster commented, or when it was time to die, they were taken to a wat, so that they would be close to an incinerator and monks for funerary rites.

The poor in Thailand now have access to some medical treatment, and this is, indisputably, a good thing. There is much room for improvement.

There is certainly no reason for some bureaucrat to claim that this health system should be emulated.

If you want to emulate a "good system" (/sarcasm), emulate the one in the US, where anyone can be dumped in front of an Emergency Room and treated. They may receive a bill after treatment, and they may even receive hounding phone calls from bill collectors for years afterwards, but there is no way to compel payment. Illegal aliens in the US get the best deal of all, in fact. Some of them remain hospitalized for years at no cost, on dialysis, even, at no charge, because they are unable to pay and are uninsured.

Passing the bill to the hospital, and to local government, bankrupting communities....now that is a plan (/snark).

[NanaFoods]

how was this conclusion arrived at, so many of my wife's elderly relatives have been simply told cant be done at your age when they needed treatment

That may be something the WHO likes !!

Edited January 25, 2012 by NanaFoods

[jaltsc]

"Dr Timothy G Evans from the BRAC University's School of Public Health said research on the implementation of the decade-old universal healthcare scheme found that the scheme covered up to 75 per cent of Thai population."

Yes, the costs are covered by this scheme...BUT...that says nothing about the quality of care. A few months ago, a Thai friend went into the local hospital and did not receive her prescribed medication for 3 days. However, on the third day the mistake was discovered and she was given all three days' medication at once. Unfortunately, she did not survive.

A friend's sister recently went into the same hospital with vaginal bleeding. She was examined, released and told that all she needed was some rest. Two days later she was severely hemorrhaging found to be caused as a result of a miscarriage which caused the initial bleeding. She returned to the hospital and barely survived after follow up treatment. Not to worry, the scheme covered all costs. Unfortunately, I don't think her funeral costs would have been covered if she had not survived the botched up service.

However, if both were farang, they would have received the same service, but in a nicer room and the bill would have been around 80,000 THB.

Yes, thiese are good reasons that the world should follow the Thai model of healthcare

The quality of care can also be very good. A little over a year ago my almost 80 year old Thai mother-in-law had major back/spine surgery in a provincial hospital...she was in the hospital for 14 days. A few days after checking and a day before the surgery she was taken by ambulance to have a lower back MRI done in Bangkok...the ambulance crew was driver and a nurse...and of course she was taken back in the same ambulance. The next evening she underwent the 4 hour surgery. Care by the hospital staff during her stay was just fine and the follow-on care via several hospital visits for checkup was fine...along with all the free medications she was issued...the abulance trip to-and-from Bangkok was free also. Her total cost for the surgery, hospital stay, medications, etc., would have been "zero" except we decided to have her stay in a private room versus a ward during her 14 days stay...for this room we paid 600 baht a day for a total of 8,400 baht...all other costs were covered by the universal health care program.

Yes, the healthcare can be very good in BKK, but It is definitely not "universal" in Thailand.

Edited January 25, 2012 by jaltsc

[GarryP]

My wife was treated for cancer under the universal healthcare scheme at a hospital near Victory Monument. Her choice not mine. She saw no reason for private healthcare when she was entitled to free care. The treatment was basically the same as private hospitals, but the service and ward was rudimentary. A few of the medicines that were not on the list of essential medicines and as such not prescribed, we bought ourselves (fluoride tablets, anasthetic gel). But the basic treatment, surgery and radiotherapy were as would have been expected under private care.

[blackthorn2005]

In the slightly adultereated lyrics of Johnny Cash: Bill, or Bob, or John....anything but Sue Maureen.

With you on that one!

[bigbamboo]

In the slightly adultereated lyrics of Johnny Cash: Bill, or Bob, or John....anything but Sue Maureen.

I was wondering who this Maureen chap was too........before he came to Thailand.

Edited January 25, 2012 by bigbamboo

[Artisi]

Yeah, right ,it's April the first , he he he.

Exactly my thoughts as well. It not a real story, is it, or is it just a stupid joke?

[SabaiBKK]

thai healthcare is a joke, a sad one . even in BMH or BNH you cannot get a doctor who actually cares about his job.

[tlansford]

Obviously not all part of the world can afford the high levels of medical care those in the developed parts have come to expect.

As an American I have absolutely no doubt that the US would have a lot to learn from Thailand in this area, as our health care system is absolutely criminal in its catering almost solely to our elites and almost complete abandonment of those most in need. The key challenge in any country is making a very minimum basic level as freely and fairly available to as many people as possible.

The fundamental problem is the focus on gee-whiz tech lets-see-whats-possible, as opposed to ensuring ordinary but critical cost-effective measures are available for all. Unfortunately such a shift means denying the most expensive solutions to the publicly supported, if the rich want to take advantage of them they their private insurance can pay for it.

In a poor country, or one where the population doesn't want the poor to be "too subsidized", what many Westerners would consider basic care needs to be denied to many.

The issue of pay for people in the medical profession is way off the charts on both ends - the US on one side, where becoming a doctor is assumed to be a guaranteed gravy train to IMO a criminal extent, and Thailand, where it is impossible for them to live on their normal salaries, and working for a hospital is basically volunteering in exchange for access to patients to promote your private after-hours services where you make your living.

I don't think anyone claims that Thailand has the whole conundrum solved, but if WHO states that it's macro-level organisational scheme is a good example for other less-developed countries to follow, I heartily congratulate this wonderful country and share in its pride for this important recognition.

Agree with the post. As an American, I agree that the USA could actually learn from Thailand - and from every industrialized country on the planet.

Just one point, however,

Unfortunately such a shift means denying the most expensive solutions to the publicly supported, if the rich want to take advantage of them they their private insurance can pay for it.

There are countries, like France & Germany, where this is not generally the case. At least I have never heard of a procedure that would only be covered if you were outside of the system. (I don't use the words "private insurance", because in France it is a mix of public and private insurances).

[tlansford]

Having seen other posters' comments, some good, some bad, I would add that my experiences with health care in Thailand have been generally positive. Private and public care seem to be about the same level of care - although not the same burden of work as anyone who has visited both private & public hospitals will know. Doctors in private hospitals often work in public hospitals, too. Sometimes there are differences in the procedures which they are allowed to offer, but I have not seen anything that is a serious deficit myself. Now, one still has to be an intelligent patient, but that is the same everywhere & not unique to Thailand.

That said, the care one receives and the system that a country implements are not at all the same thing. Seems obvious.

The system in Thailand has brought health care to people who did not have access to it before, has reduced poverty, provided care to poor citizens, and, as stated in the article, covers 75% of the population. (I thought it would have been higher, actually). Those are pretty important accomplishments. A system which can do that in a relatively poor country does seem like a good example to use for countries which have not achieved the same results.

No system is perfect, but when it comes to access for health care, Thailand has done a much better job than some others. The need for improvement is still easy to see, and people have already noted some of the problems in this thread.

I recently found an interesting article on the distribution of medical care in rural areas of Thailand. I repost it here because it contains a nice historical view of health care in Thailand and might be interesting for others.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC317381/

[moe666]

My mother-in-law died of cancer at home after a few weeks of perfunctory treatment in a government hospital near the Victory Monument.

They had no funds to provide her with effective pain killers, and she was in great pain as she declined. My best friend, on the other hand, a foreigner with sufficient assets, was hospitalized at Bangkok Hospital while he faded way with cancer. He had IV Demerol as needed for pain. He had battled the malady for two years through a combination of chemotherapy and surgeries.

Grandma's treatment at the government hospital was nightmarish. It was packed with desperately ill people patiently waiting for charity. The nurses and the doctors did their best with what they had, but they often lacked basic medical supplies. At times, their patience ran low. I can only imagine their frustration and their feeling of helplessness, particularly knowing that they could have done more with better funding.

The only reason that Thailand's current health scheme is "good" is because it exists, whereby previously there was nothing in its place. The ill simply stayed home, as an earlier poster commented, or when it was time to die, they were taken to a wat, so that they would be close to an incinerator and monks for funerary rites.

The poor in Thailand now have access to some medical treatment, and this is, indisputably, a good thing. There is much room for improvement.

There is certainly no reason for some bureaucrat to claim that this health system should be emulated.

If you want to emulate a "good system" (/sarcasm), emulate the one in the US, where anyone can be dumped in front of an Emergency Room and treated. They may receive a bill after treatment, and they may even receive hounding phone calls from bill collectors for years afterwards, but there is no way to compel payment. Illegal aliens in the US get the best deal of all, in fact. Some of them remain hospitalized for years at no cost, on dialysis, even, at no charge, because they are unable to pay and are uninsured.

Passing the bill to the hospital, and to local government, bankrupting communities....now that is a plan (/snark).

Who do you think is paying for the emergency room treatment in the states, Long suffering tax payers (snark)

[harryfrompattaya]

Now if they could only find a way to pay the doctors and nurses salary.........

Exactly!!! My partner is a respiratory physician working at a government hospital and sometimes has to go months without receiving his salary on time, which is already far less than a manager at McDonald's. He and several of his colleagues would have left this "exemplary model" already if they weren't tied down for years by predatory government contracts.

Maybe that is what he tells you so he get a more money from you. My sister in law has no problem getting paid and does very well as a physician.

Edited January 25, 2012 by harryfrompattaya

[anterian]

In recent survey in England the level of healthcare was not uniforms but varied by region, I'm sure the same applies in most countries, including Thailand.