Bt300 Wage Forces Bangkok's Siriraj Hospital To Hike Fees

[webfact]

Bt300 wage forces Siriraj to hike fees

The Nation

Low-cost drug policy also contributed to loss of income, Mahidol dean says

BANGKOK: -- Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs due to the Bt300 wage policy and losing Bt1 billion in income to the government's measures to reduce drug expenses, the dean of Mahidol University's Medicine Faculty said.

The Bt300 wage and the policy to raise degree holders' monthly salary to Bt15,000 had affected the hospital's finances, because the government fund for salary adjustment covered only civil servants and university employees, not the 4,000-5,000 Siriraj employees, who deserved an equal right to a pay hike, Dr Udom Kachintorn said yesterday.

Thus, the hospital would have to use Bt800 million a year from its own pocket for this purpose. The policy to use domestically made generic drugs rather than imported drugs had also cost the hospital around Bt1 billion in income last year, Udom said.

Insisting that the hospital would follow the government's policies, and that it has no policy to lay people off despite the heavier financial burden, Udom said Siriraj aimed to care for its personnel until after retirement in all respects.

Adjustments Ahead

Thus, the hospital would adjust fees for services such as hospital beds and treatments this year, while also trying to cut expenses and costs. It will also try to earn extra via joint research projects with private companies.

Public Health permanent secretary Narong Sahamethapat said a working team would soon come up with an adjusted schedule of fees for medical services for Public Health Ministry hospitals.

In related news, Thai Labour Solidarity Committee President Chalee Loysung urged the government to set up a fund to pay compensation to laid-off workers, to aid workers in negotiations with employers, and help laid-off workers find new jobs.

Many employers had used the wage hike as an excuse to fold their business without paying legal compensation or treating workers fairly, he said, adding that many factories that had suffered cumulative losses were claiming they had to fold because of the wage hike.

Among the examples was Electrolux Thailand (Rayong), a washing-machine manufacturer with capacity to build over one million machines a year and employing 650 people. The committee said that, on January 10, the company's labour union negotiated with executives for an appropriate pay hike for all, rather than adjusting solely for those earning less than Bt300 a day regardless of how long they had worked for the company.

The firm responded the next day by saying it couldn't meet such a demand, leading to the firing of a union committee and union members that same afternoon.

While some factories haven't laid off workers, many workers had to work longer hours, posing the risk of accidents or illness, the committee said. Pressured by rising costs, employers had increased working hours, and put the work environment second, it said.

-- The Nation 2013-01-24

[manarak]

and it begins...

[noob7]

"Bt300 wage forces abc-xyz to hike fees"

Wouldn't that describe it better?

[arthurboy]

It would be good to see Sirirajs' public accounts and balnace sheets before we hear about any more medical faculty deans and senior doctors crying over their share of the hospital's budget.

We also might like to know why doctors are exempt from paying income tax.

And, we also might like to know the exact financial relationship between drug companies and the doctors who prescribe their medicines.

Edited January 24, 2013 by arthurboy

[chooka]

"Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs"

How many employees do they have on the 300 baht wage? (1,500 per week) There has to be a lot to push up there wage costs by 800 million.

[hellodolly]

We are just starting to see the unions reaction to the wage hikes. Pretty soon they will all want a big jump in pay. All ready the freight handlers in the airports are demanding more.

[Stradavarius37]

Oh good, even more expensive but still shoddy medical treatment.

Siriraj is one of the best hospitals in the world actually. Sure would be nice if you knew what you were talking about . I do, so feel free to argue in futility !

[Thai at Heart]

Ridiculous story.

I have a feeling that the hike in rates will more than cover the increase in salaries. The 300 baht is for MINIMUM wage employees. If the management want to hike for everyone, one would have to conclude they were underpaying everyone before.

[Stradavarius37]

"Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs" How many employees do they have on the 300 baht wage? (1,500 per week) There has to be a lot to push up there wage costs by 800 million.

Siriraj hospital serves close to 1 million inpatients and 4 million outpatients per year. Its enormous. If you have ever gone and seen the 75 buildings that make up the hospital, you will see that the figure sounds pretty spot on.

Edited January 24, 2013 by Stradavarius37

[Stradavarius37]

Ridiculous story. I have a feeling that the hike in rates will more than cover the increase in salaries. The 300 baht is for MINIMUM wage employees. If the management want to hike for everyone, one would have to conclude they were underpaying everyone before.

Siriraj is definitely not a profit making entity. lol They give treatment to millions for no fee. My father in law just spend 3 weeks there for heart problems - total cost to him 0 baht.

[whatsupdoc]

Ridiculous story.

I have a feeling that the hike in rates will more than cover the increase in salaries. The 300 baht is for MINIMUM wage employees. If the management want to hike for everyone, one would have to conclude they were underpaying everyone before.

If you raise the minimum wage you probably have to raise all wages otherwise you might get some very unhappy employees. It is not ridiculous, it's common sense.

[NeverSure]

With all due respect, I quoted far earlier that "a rising tide lifts all boats." - author unknown.

When you have a big increase in minimum wage, you lift some of those people above others who were just above minimum wage. Now you have to give those people a raise because they have been there longer, have more responsibility...

And so it goes up the ladder. Everyone gets a raise to maintain "fairness." Then prices must rise to cover the costs.

THEN the minimum wage people didn't get a real raise at all. They just have more money to pay the new higher prices that will be attached to everything.

The people who get hurt are those on fixed incomes. Did anyone's bank account take a jump or did retirement incomes, even for Thai citizens jump? Did the price of rice or rubber or other commodities go up? No, because they are commodities with international competition. The Thai government took a bath on rice because they forgot that.

This is a mess. Let's see how it sorts out.

[robblok]

It will mainly hit exports and expats that are on fixed incomes retirees and such. They wont be able to increase pay to their "girlfriends" and will have to drink their beers outside a 711 instead of in a bar.

The whole raising does not do anyone any good as all prices go up.

[arthurboy]

Oh good, even more expensive but still shoddy medical treatment.

Siriraj is one of the best hospitals in the world actually. Sure would be nice if you knew what you were talking about . I do, so feel free to argue in futility !

Yes, a little harsh and, of course, an unfair generalisation.

However, as an ex nurse of some 24 years experience, especially in Accident and Emergency, I have observed and experienced first hand that the standard of care in many, many hospitals in Thailand - both public and private - is shoddy.

Edited January 24, 2013 by arthurboy

[Thai at Heart]

Ridiculous story.

I have a feeling that the hike in rates will more than cover the increase in salaries. The 300 baht is for MINIMUM wage employees. If the management want to hike for everyone, one would have to conclude they were underpaying everyone before.

If you raise the minimum wage you probably have to raise all wages otherwise you might get some very unhappy employees. It is not ridiculous, it's common sense.

How many of their thousands of employees are on minimum? If they want to push up everyone, that is managements problem.

[horsewell]

So this is the final 70 provinces. Probably see a lot of stories like this. I'm sure that prices have been already pushed up around the country and over the next few weeks they will go up some more. That said Phuket hasn't increased in price that much, but then it depends on your knowledge and expectations.

[OzMick]

Ridiculous story.

I have a feeling that the hike in rates will more than cover the increase in salaries. The 300 baht is for MINIMUM wage employees. If the management want to hike for everyone, one would have to conclude they were underpaying everyone before.

If you raise the minimum wage you probably have to raise all wages otherwise you might get some very unhappy employees. It is not ridiculous, it's common sense.

How many of their thousands of employees are on minimum? If they want to push up everyone, that is managements problem.

So is industrial unrest. Extra payment for skill, responsibility and extra duties should be dumped because the minimum wage was raised?

BTWt the OP clearly states that the B15,000 for graduates is part of the problem. One might hope that a hospital has a few, and that posters bother to read the OP.

Edited January 24, 2013 by OzMick

[geriatrickid]

Let's deal with the facts.The personnel head count at the hospital is as follows (this is an approximate head count);

850 physicians, 7,500 nurses and 2,000 nurse assistants and 1200 support staff.

Pay increases were given to nurses to keep them at the hospital as there is a nursing shortage. This has been in the news and has nothing to do with the 300 baht minimum wage.

It is no secret that the hospital has also faced a serious drain on its physicians and has been forced to offer financial incentives to retain doctors. It is amazing that in 1996 the physician head count was close to 1900.

The nurse assistants have always been paid significantly more than the minimum and if their pay was increased it has more to do with the incentives offered from other sectors to change jobs.

This leaves the 1200 or so support staff. Included in this number is the administration cadre, with accountants, managers, skilled technicians and other people all of whom are making significantly more than the minimum. This leaves perhaps a few hundred orderlies, cleaners, security staff. An additional 20-50 baht a day for 500 people isn't going to skew the budget. Do the math and it works out to about 5million baht per annum.

The real cuplrit has been the inability of the hospital to avail itself of the high profit margins associated with proprietary drugs.

This was a profit maker for the hospital.

Keep in mind that the hospital is also a teaching hospital and the costs associated with the facility combined with the fact that it provides low cost services, means that the hospital was starting with high overhead costs making it even more dependent upon the hidden profits provided by the drug sales. As well, the large incentive payments given to the physicians and nurses made the problem worse.

This has nothing to do with giving some of the lowest paid workers an increase of between 30 and 50 baht per day. Rather, it highlights that the government has mandated the hospital to act as a teaching facility and to provide low cost care, yet not compensated the hospital for those costs.

This article is such crap. It is easier to blame some labourer when the real culprit is deficient health policy, large payments given to certain workers and the refusal to compensate the hospital for the social services it provides. This article demonstrates both bias and an abject refusal to do some critical thinking.

Edit to add personal comment: Hello Dean of the medical faculty: Perhaps you should consider picking up some of the costs that your students create. The hospital provides the intern and residency positions for your medical school. The university is collecting the fees. It will be interesting to see if Mahidol shares some of those fees with the hospital.

Edited January 24, 2013 by geriatrickid

[Stradavarius37]

Oh good, even more expensive but still shoddy medical treatment.

Siriraj is one of the best hospitals in the world actually. Sure would be nice if you knew what you were talking about . I do, so feel free to argue in futility !

Yes, a little harsh and, of course, an unfair generalisation.

However, as an ex nurse of some 24 years experience, especially in Accident and Emergency, I have observed and experienced first hand that the standard of care in many, many hospitals in Thailand - both public and private - is shoddy.

I would not disagree about your assessment of many hospitals in LOS - just wanted to make sure that we weren't tarring everyone with the same brush, there are exceptions.

[slapout]

Blame someone/something that is out of your realm of control for self induced problems that managment is paid to handle or at least explane. I doubt this facility has ever had a positive P&L statement.

I have no experience nor personal knowledge of this instituation, but so many Thai public companies/facilities give so many feebies to civil servent, government officials and their extended families that any of them are expected to provide more than a loss/expense sheet is surprising.

[Stradavarius37]

Blame someone/something that is out of your realm of control for self induced problems that managment is paid to handle or at least explane. I doubt this facility has ever had a positive P&L statement.

I have no experience nor personal knowledge of this instituation, but so many Thai public companies/facilities give so many feebies to civil servent, government officials and their extended families that any of them are expected to provide more than a loss/expense sheet is surprising.

Its a government hospital - not trying to make a profit - its trying to help sick people lol. You statement in bold - my response "Exactly, you don't"

[slapout]

Blame someone/something that is out of your realm of control for self induced problems that managment is paid to handle or at least explane. I doubt this facility has ever had a positive P&L statement.

I have no experience nor personal knowledge of this instituation, but so many Thai public companies/facilities give so many feebies to civil servent, government officials and their extended families that any of them are expected to provide more than a loss/expense sheet is surprising.

Its a government hospital - not trying to make a profit - its trying to help sick people lol. You statement in bold - my response "Exactly, you don't"

To ask a question toward your knowledge and my lack thereof, of this facility, If they are not trying to make a profit, what difference will an additional 1.8 billion baht loss make on their books as well as in the grand scheme of the populist government spending, that is taking place now?

[NeverSure]

Let's deal with the facts.The personnel head count at the hospital is as follows (this is an approximate head count);

850 physicians, 7,500 nurses and 2,000 nurse assistants and 1200 support staff.

Pay increases were given to nurses to keep them at the hospital as there is a nursing shortage. This has been in the news and has nothing to do with the 300 baht minimum wage.

It is no secret that the hospital has also faced a serious drain on its physicians and has been forced to offer financial incentives to retain doctors. It is amazing that in 1996 the physician head count was close to 1900.

The nurse assistants have always been paid significantly more than the minimum and if their pay was increased it has more to do with the incentives offered from other sectors to change jobs.

This leaves the 1200 or so support staff. Included in this number is the administration cadre, with accountants, managers, skilled technicians and other people all of whom are making significantly more than the minimum. This leaves perhaps a few hundred orderlies, cleaners, security staff. An additional 20-50 baht a day for 500 people isn't going to skew the budget. Do the math and it works out to about 5million baht per annum.

The real cuplrit has been the inability of the hospital to avail itself of the high profit margins associated with proprietary drugs.

This was a profit maker for the hospital.

Keep in mind that the hospital is also a teaching hospital and the costs associated with the facility combined with the fact that it provides low cost services, means that the hospital was starting with high overhead costs making it even more dependent upon the hidden profits provided by the drug sales. As well, the large incentive payments given to the physicians and nurses made the problem worse.

This has nothing to do with giving some of the lowest paid workers an increase of between 30 and 50 baht per day. Rather, it highlights that the government has mandated the hospital to act as a teaching facility and to provide low cost care, yet not compensated the hospital for those costs.

This article is such crap. It is easier to blame some labourer when the real culprit is deficient health policy, large payments given to certain workers and the refusal to compensate the hospital for the social services it provides. This article demonstrates both bias and an abject refusal to do some critical thinking.

Edit to add personal comment: Hello Dean of the medical faculty: Perhaps you should consider picking up some of the costs that your students create. The hospital provides the intern and residency positions for your medical school. The university is collecting the fees. It will be interesting to see if Mahidol shares some of those fees with the hospital.

With all due respect, you are overlooking the "domino effect." Who provides the food for the hospital. I mean, who delivers it and grows it? Who handles it? Who provides all of the other items that come into that hospital that the "support staff" uses? Who makes the garments offsite? How about all of the rest of the work done offsite to repair or replace basic equipment like floor cleaning equipment and supplies? Who delivers it? Who puts the fuel in the trucks that make the deliveries? Who washes them for the vendors?

There is an army of offsite, low skilled workers who are loading and unloading trucks in warehouses just to make deliveries.

You can't count just the people who are registered as employees of the hospital. For all we know, that may not represent even half of the jobs created by the hospital. The hospital's costs are going to go up in every area at least some. This is a rising tide which will flow through the country.

In every economy, someone is always at the bottom. Move the bottom rung of a ladder up and you raise every rung, netting nothing of value for those who are still on the bottom. Those on the bottom rung are therefore still just as far from the next rung up, and from the top rung, as they were before the ladder was raised at the bottom.

Edited January 24, 2013 by NeverSure

[cbrer]

"Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs"

How many employees do they have on the 300 baht wage? (1,500 per week) There has to be a lot to push up there wage costs by 800 million.

The umbrella also covers all degree holders to earn 15k p/m minimum.

"850 physicians, 7,500 nurses and 2,000 nurse assistants"

Many of the last two are probably degree'd and were earning less than 15k.

[noob7]

. did retirement incomes, even for Thai citizens jump?

Up to this point, retirement income is almost only going to 'ex'-government people. Army, Police, ...., and politicians, of course.

I think, the majority of the retirees in Thailand will get there compensation, soon.

[geriatrickid]

"Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs"

How many employees do they have on the 300 baht wage? (1,500 per week) There has to be a lot to push up there wage costs by 800 million.

The umbrella also covers all degree holders to earn 15k p/m minimum.

"850 physicians, 7,500 nurses and 2,000 nurse assistants"

Many of the last two are probably degree'd and were earning less than 15k.

Hmmmmmm.................

Basic International Salary Report

Summary

The Nurse Registered working in All Thailand, All Thailand now earns an average annual salary of 1,656,857. Half of those in this position would earn between 1,270,809 and 1,951,777(the 17th and 67th percentiles). These numbers are derived from real, area specific, survey data.

(Note: These are conservative government estimates.))

When benefits and bonuses are added to this salary, the average total compensation for this position would be 1,718,705. The report below also explains how the cost of living in this location affects the actual value of this salary.

Estimates as of 23-Jan-2013. Currency in Thai Baht.

Source data is derived from non-copyrighted government salary surveys from each country's National Labor/Statistics Office

Newly graduated Non registered nurses, such as auxilliary nurses were being offered minimum salaries of Bt20,000 a month in addition to cash incentives and generous educational subsidies as was reported by the Nation in 2011.

Not everyone in Thailand works for a minimum, especially when it is estimated that Thailand needs another 40,000 nurses.

There is a skilled labour shortage in Thailand. I don't think foreigners quite understand this, unless they are related to a business that relies on skilled labour or have international business experience.

[noob7]

There is a skilled labour shortage in Thailand. I don't think foreigners quite understand this, unless they are related to a business that relies on skilled labour or have international business experience.

I can see that, every day. There are not enough skilled Thais, to work in road or house construction.

They have to bring the skills in, from Burma.

Edited January 24, 2013 by noob7

[OzMick]

There is a skilled labour shortage in Thailand. I don't think foreigners quite understand this, unless they are related to a business that relies on skilled labour or have international business experience.

I can see that, every day. There are not enough skilled Thais, to work in road or house construction.

They have to bring the skills in, from Burma.

As an alternative, they could stop wasting money on rice scams and pie-in-the-sky schemes and spend some real money on educating their people.

[geriatrickid]

With all due respect, you are overlooking the "domino effect." Who provides the food for the hospital. I mean, who delivers it and grows it? Who handles it? Who provides all of the other items that come into that hospital that the "support staff" uses? Who makes the garments offsite? How about all of the rest of the work done offsite to repair or replace basic equipment like floor cleaning equipment and supplies? Who delivers it? Who puts the fuel in the trucks that make the deliveries? Who washes them for the vendors?

There is an army of offsite, low skilled workers who are loading and unloading trucks in warehouses just to make deliveries.

You can't count just the people who are registered as employees of the hospital. For all we know, that may not represent even half of the jobs created by the hospital. The hospital's costs are going to go up in every area at least some. This is a rising tide which will flow through the country.

In every economy, someone is always at the bottom. Move the bottom rung of a ladder up and you raise every rung, netting nothing of value for those who are still on the bottom. Those on the bottom rung are therefore still just as far from the next rung up, and from the top rung, as they were before the ladder was raised at the bottom.

Fair criticism and you make a valid point. However, please note that much of the hospital supplies are sourced from China and India. Incredible isn't it? For example, China has a stranglehold on hospital gowns. They are manufactured, wrapped for use, boxed and sent directly from China to the monopoly that supplies hospitals in Thailand. Another example are surgical instruments. India is one of the lowest cost suppliers of scalpels and scalpel blades in the world. (Interesting piece of trivia: Ever since India took the lead, the number of breakages and instrument failures has increased. Hearsay opinion, that I cannot substantiate as there is no incentive for hospitals to report as it adds fodder to malpractice claims.) Most advanced medical devices are sourced outside of Thailand. e.g. EU, Japan, Taiwan, Korea, USA China & Korea. Yes, there has been a trickle down effect from basic provisioning supply cost increases. However, I would expect that some of the costs have been offset by the strength of the baht making imports cheaper. Now if you would say, why haven't those FX benefits been passed on, I'd say, please ask the Thai distributors why not. They might say their costs increased and their supply contract costs increased so they used the savings to offset those increases.

I won't argue your main point, as it is valid, however, it is not as significant as one would conclude from your argument. The public hospitals have been outsourcing many of the activities they once handled themselves. This has allowed the hospitals to cut staff and the associated costs. For example, in the case of this hospital I believe the multinational foreign firm SODEXO won some of the food and cafeteria supply contracts. The workers are no longer able to claim benefits under the public servant scheme and instead are employed by a private contractor that most likely has a less generous benefits and pay package.

I think the key issue though is that the hospital prices its services below cost. In plain language the business model is set up so that the hospital loses money. There was an over reliance on the profit margins of the proprietary drugs. The failure is in the government not to compensate the hospital for the services provided to the general public. The hospital administration was slow to respond to to a crisis that was evident as soon as the government announced the move to generics. As well, there is a lack of responsibility assumed by the MoH and to a lesser extent Mahidol which directly benefits from the hospital. The frequency and severity of cases provides valuable training to the residents and interns. BTW, this group of cheap labour has not benefitd from the increased wages. They are still unfairly compensated for all the work they do. (Thailand isn't different than any other country in that regard.)

[CMTourist]

"Siriraj Hospital plans to hike its fees this year after shouldering an additional Bt800 million in wage costs"

How many employees do they have on the 300 baht wage? (1,500 per week) There has to be a lot to push up there wage costs by 800 million.

The umbrella also covers all degree holders to earn 15k p/m minimum.

"850 physicians, 7,500 nurses and 2,000 nurse assistants"

Many of the last two are probably degree'd and were earning less than 15k.

Hmmmmmm.................

Basic International Salary Report

Summary

The Nurse Registered working in All Thailand, All Thailand now earns an average annual salary of 1,656,857. Half of those in this position would earn between 1,270,809 and 1,951,777(the 17th and 67th percentiles). These numbers are derived from real, area specific, survey data.

(Note: These are conservative government estimates.))

When benefits and bonuses are added to this salary, the average total compensation for this position would be 1,718,705. The report below also explains how the cost of living in this location affects the actual value of this salary.

Estimates as of 23-Jan-2013. Currency in Thai Baht.

Source data is derived from non-copyrighted government salary surveys from each country's National Labor/Statistics Office

Newly graduated Non registered nurses, such as auxilliary nurses were being offered minimum salaries of Bt20,000 a month in addition to cash incentives and generous educational subsidies as was reported by the Nation in 2011.

Not everyone in Thailand works for a minimum, especially when it is estimated that Thailand needs another 40,000 nurses.

There is a skilled labour shortage in Thailand. I don't think foreigners quite understand this, unless they are related to a business that relies on skilled labour or have international business experience.

This is really hard to believe.

Nurses making 150,000 Baht a month on average across all of Thailand? I'd be surprised if that was even the average wage for doctors.

If this were true then nurses would all be turning up to work in Benzes and they'd be the most desirable women in Thailand to a huge number of the local men.

And why would any Thai go for any other degree when you can get an average salary of 150k with a 3 year nursing degree?

Its just not plausible

I meet nurses every now and then in discos and night clubs in Bangkok. They work at Bumrungrad and the like. They are NOT on 150k a month!