Medical Hub Must Work For Thais, Not Just Tourists

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EDITORIAL

Medical hub must work for Thais, not just tourists

The Nation

BANGKOK: -- The country's healthcare system still needs more doctors, nurses and better treatment for everyone, regardless of the ability to pay.

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The plan to turn Thailand into a medical hub has been around for years. Although no government has yet produced any concrete action, Thailand continues to receive many foreign patients due to the good skills and service of physicians and other medical staff here.

The trend is welcome, for it suggests the services and capacity of the Thai medical sector is of international standard. But while the government concentrates on visa incentives to encourage foreigners to visit, there are other issues it should address to make the medical hub plan sustainable and beneficial for all Thais.

Many private hospitals here have earned an international reputation for providing world-class service. So it's ironic that many Thais are still struggling with bad service, inadequate medical equipment and a shortage of doctors, especially at public hospitals in the rural areas.

The government recently eased visa requirements for visitors from six Middle Eastern countries seeking medical treatment here. They no longer need to get a visa in advance. Public Health Minister Dr Pradit Sinthawanarong says this "privilege" is part of the campaign to become a regional medical hub.

Medical services provided to foreigners generate Bt120 billion a year for the Thai economy, but critics claim a connection between the shortage of doctors and nurses at public hospitals and the boom in private hospitals accommodating foreign patients.

Regardless, even without the goal of becoming a medical hub, Thailand needs to overhaul its medical training to produce more doctors and nurses for the entire system. It is estimated that 40,000 more doctors are needed to ensure quality healthcare, but only 2,500 graduate every year, according to the Private Hospital Association. Therefore, the booming business of private hospitals is not the only factor causing the shortage of personnel in the system.

According to a Health Ministry report, Thailand has 43,424 physicians working at public and private hospitals across the country. To provide adequate services, that figure needs to be doubled. The "2011 World Health Statistics" report by the World Health Organisation showed that in Thailand there are just three physicians for every 10,000 patients, compared to 18.3 in Singapore, 9.4 in Malaysia, 11.5 in the Philippines and 12.2 in Vietnam. In Norway, the United Kingdom and US, the ratios were 42, 27 and 24.

The medical training should engage the private sector in order to ease the financial burden on the government and create more flexibility in the system. This shortage of doctors has to be resolved to enhance the country's competitiveness ahead of the advent of the Asean Economic Community in 2015. The AEC will mean that, in the near future, doctors here will not only have to serve 67 million Thais but also more than 3 million foreigners, including migrant workers and tourists.

The medical hub plan should go along with a workable plan to create more qualified physicians to serve both local and foreign patients. Relaxation of the entry-visa rule is not a determining factor. Patients do not choose to receive medical treatment simply because of visa issues. They need good treatment and services, and pharmaceuticals they can trust. There are also certain regulations that make some pharmaceutical products unavailable in Thai hospitals, partly because of the government's policy to promote the use of locally made drugs. However, some local and foreign patients prefer to use pharmaceutical products they are familiar with.

At any rate, the overall plan and details to transform Thailand into a medical hub will have to evolve from thorough discussion among all parties involved - the Health Ministry, public and private hospital operators, concerned agencies and organisations and the public and patients themselves.

Regardless of the medical hub plan, the Thai healthcare system must be improved anyway, primarily for the best interest of Thais.

Thailand has made progress by providing access to all Thais to healthcare. But more has to be done to ensure that the people also get good service. The medical hub plan, if realised, should also support that aim.

-- The Nation 2013-02-14

[Lingba]

Oh no..not again....Medical Hub????

[Hornell]

"According to a Health Ministry report, Thailand has 43,424 physicians working at public and private hospitals across the country. To provide adequate services, that figure needs to be doubled. The "2011 World Health Statistics" report by the World Health Organisation showed that in Thailand there are just three physicians for every 10,000 patients, compared to 18.3 in Singapore, 9.4 in Malaysia, 11.5 in the Philippines and 12.2 in Vietnam. In Norway, the United Kingdom and US, the ratios were 42, 27 and 24."

Some interesting statistics here and show precisely why one has to aim off for a complete day at a public hospital for even a minor call. Equally at the smarter private hospitals, although the waiting is much less, the number of people (Thais and foreigners) attending them seems to be increasing, almost by the week, in spite of the burgeoning cost of these hospitals. Three physicians per thousand patients is an appalling ratio and scarcely gives Thailand the right to claim itself as a 'medical hub'.

[Hornell]

Re my last post - regret typo - 'three physicians per TEN thousand patients' not one thousand as I wrote!

[culicine]

Perhaps the government should start paying their regular doctors a salary commensurate with their training, rather than blaming them for pursuing a higher salary in the private sector. A good friend needed to open his own practice to make ends meet, while working in a government hospital. The problem with AEC, for Thailand is that it really opens the market to competition.

[mickjn]

What a great thing altough they have been very good with their people.Doctors up country offered good jobs in BKK but will not come stay and help the people where they were born,money is not everything to them

[belg]

mhhh, medical tourists, they pay full price, we farang living here, pay full price... but thais should get it for free? because? most of them don't pay taxes ? most who pay taxes likes to avoid ? most governemnt officials like to make 20-30.000 baht per month of selling medicine they don't need as an extra ???????

you should get what you pay for .... pay 0 baht tax and socials security = cheapest of cheapest medical care

[rubl]

I'm sure the 30 Baht the current government made Thai people pay for health services guarantees an adequate service level and is more than sufficient to cover costs and even allow for service improvements.

At least that's what government officials have been saying

[Payboy]

Hubba Hubba

[Thai at Heart]

I find it interesting that they consider the situation to be that no other countries in the region will be able to provide private health care and that for some reason Thailand has a potential monopoly on this medical tourism business in the region.

Yes they have affordable private hospitals, but I am not quite sure that constitutes a hub.

[atyclb]

The geniuses in charge might consider licensure reciprocity for doctors from other countries especially G7 and the likes where training, licensure and standards are aspired to by Thai doctors.

At Mahidol SOM it is the dream of many to train in the USA, yet a USA licensed doctor cannot work in thailand even just seeing english speaking patients. Thai medicine has little or no innovation, it all comes from abroad, yet their nationalism blinds them. Perhaps insecurity mixed in?

Edited February 14, 2013 by atyclb

[Thai at Heart]

The geniuses in charge might consider licensure reciprocity for doctors from other countries especially G7 and the likes where training, licensure and standards are aspired to by Thai doctors.

At Mahidol SOM it is the dream of many to train in the USA, yet a USA licensed doctor cannot work in thailand even just seeing english speaking patients. Thai medicine has little or no innovation, it all comes from abroad, yet their nationalism blinds them. Perhaps insecurity mixed in?

It really makes you wonder, looking at the englsih abilities of Thai doctors, how they work through all of the english language research papers and documents. I have a relative doing vetinary science, and about 75% of the documents are in english. do they understand absolutely 100%?

[seminomadic]

I don't know what the author's whining about, not benefitting Thais enough. Doesn't she know that it just means more foreigners coming to TH who Thais can double-price before and after they're in the hospital?

[boomerexpat]

The government already seems to be working diligently to make sure it doesn't turn into a medical tourist hub.

when I was in Thailand last year, I got really sick and my doctor didn't want me to travel until fully well so the hospital escorted me to immigration for an extension of my visa for the period prescribed by my doctor who practiced at one of the top hospitals. He said he had done that before and there would be no problem. There was also some kid of Indian descent in the hospitals little roadshow who grew up in Thailand and whose parents were residents there; he went to college in the US.

The doctor at immigration told both of us: "we don't need you in Thailand. Go back to your own country for care."

All he would do was extend our visas for the standard one week.

The kid's father chewed him out and told him the doc was mad because we made the mistake of not putting a big baht bill in our passport when we handed it over to pay the doc off. Live and learn.

[Suffinator]

30 Baht Healthcare =

[rubl]

The geniuses in charge might consider licensure reciprocity for doctors from other countries especially G7 and the likes where training, licensure and standards are aspired to by Thai doctors.

At Mahidol SOM it is the dream of many to train in the USA, yet a USA licensed doctor cannot work in thailand even just seeing english speaking patients. Thai medicine has little or no innovation, it all comes from abroad, yet their nationalism blinds them. Perhaps insecurity mixed in?

It really makes you wonder, looking at the englsih abilities of Thai doctors, how they work through all of the english language research papers and documents. I have a relative doing vetinary science, and about 75% of the documents are in english. do they understand absolutely 100%?

When you're admitted to a hospital here you have to sign some papers. Depending on the hospital they might even be in Thai. Do you understand 100% of that?

Mind you, once at Immigration I signed a paper on which I could only read "the accused", somehow exactly at the position where I was told to sign

[Thai at Heart]

The geniuses in charge might consider licensure reciprocity for doctors from other countries especially G7 and the likes where training, licensure and standards are aspired to by Thai doctors.

At Mahidol SOM it is the dream of many to train in the USA, yet a USA licensed doctor cannot work in thailand even just seeing english speaking patients. Thai medicine has little or no innovation, it all comes from abroad, yet their nationalism blinds them. Perhaps insecurity mixed in?

It really makes you wonder, looking at the englsih abilities of Thai doctors, how they work through all of the english language research papers and documents. I have a relative doing vetinary science, and about 75% of the documents are in english. do they understand absolutely 100%?

When you're admitted to a hospital here you have to sign some papers. Depending on the hospital they might even be in Thai. Do you understand 100% of that?

Mind you, once at Immigration I signed a paper on which I could only read "the accused", somehow exactly at the position where I was told to sign

Well, having been wrongly diagnosed 3 times at my local hospital, I call my father who was a medical man, and he calls around his mates to give me a diagnosis before I go. I am not saying its good or bad, it is just that trying to produc more doctors in a short period of time, isn't easy because at the end of the day, it does require quite an excellent grasp of foreign languages to undertake the course.

Signing a document to check in, isn't quite as dangerous as having a doctor who isn't 100% sure from his training what he is doing. There are some excellent doctors here, no doubt.

[barrybankruad]

Don't know how many of you were here before the 30 baht scheme was introduced, I was. Very often these 'fake''quacks' would come round the village 'administering' cures and remedies to the locals. I don't know what they charged but it must have been cheaper than the local state hospital.

Ono day I saw one 'treating' a bunch of locals. There was a 'flu bug going round the village and quite a few locals had caught it. I couldn't believe my eyes when I saw what he was doing. He was injecting people one after the other using the SAME DIRTY NEEDLE! i yelled at him asking hadn't he heard of AIDS? I told him that if he ever came close to any member of my family I would kill him. Not very diplomatic I know But I was very angry. He promptly packed up his 'medicine chest' and left in a hurry. What he was doing was illegal.

Shortly thereafter the 30 baht scheme was introduced and we never saw the likes of him again. I am well aware that the state hospitals often leave something to be desired, but IMHO the scheme was (and is) the best thing that happened for the health of rural Thailand.

[rubl]

Don't know how many of you were here before the 30 baht scheme was introduced, I was. Very often these 'fake''quacks' would come round the village 'administering' cures and remedies to the locals. I don't know what they charged but it must have been cheaper than the local state hospital.

Ono day I saw one 'treating' a bunch of locals. There was a 'flu bug going round the village and quite a few locals had caught it. I couldn't believe my eyes when I saw what he was doing. He was injecting people one after the other using the SAME DIRTY NEEDLE! i yelled at him asking hadn't he heard of AIDS? I told him that if he ever came close to any member of my family I would kill him. Not very diplomatic I know But I was very angry. He promptly packed up his 'medicine chest' and left in a hurry. What he was doing was illegal.

Shortly thereafter the 30 baht scheme was introduced and we never saw the likes of him again. I am well aware that the state hospitals often leave something to be desired, but IMHO the scheme was (and is) the best thing that happened for the health of rural Thailand.

I doubt anyone here questions the scheme itself. It's the funding of the scheme which was never really sufficient. The PM Surayuth led government abolished the 30 Baht, but kept the scheme, although still underfunded. The current government introduced the Thaksin 30 Baht again, but didn't do anything to improve the budget. There was even a suggestion that re-introducing the 30 Baht would allow for service improvements.

Of course healthcare is a costly aspect of taking care of a population. Western countries, Japan, etc. have similar problems. Still, promoting part of the medical corps to 'migrate' from public to private hospitals doesn't seem right. Of course those private hospitals will serve anyone (who'se willing to pay). In a country were 300 Baht/day is target of heavy discussions, that's like stating anyone can buy a RollsRoys

Edited February 14, 2013 by rubl

[Time Traveller]

Buyer beware for any foreigners that come to this medical hub for treatment. If ever they had to file a malpractice suit against a Thai hospital or doctor they are going to be sorely disappointed. Unlike Western countries where medical professionals actually have insurance policies worth more than a few baht.

[atyclb]

The geniuses in charge might consider licensure reciprocity for doctors from other countries especially G7 and the likes where training, licensure and standards are aspired to by Thai doctors.

At Mahidol SOM it is the dream of many to train in the USA, yet a USA licensed doctor cannot work in thailand even just seeing english speaking patients. Thai medicine has little or no innovation, it all comes from abroad, yet their nationalism blinds them. Perhaps insecurity mixed in?

It really makes you wonder, looking at the englsih abilities of Thai doctors, how they work through all of the english language research papers and documents. I have a relative doing vetinary science, and about 75% of the documents are in english. do they understand absolutely 100%?

I prepared some of them for the US medical licensure exam. IMO, their english was quite adequate as well as knowledge. we could have easily been colleagues working together. That is Mahidol central campus not the hospital by the river, which is more provincial in nature. Away from the famous big city universities, english skills decline markedly.

[chiangmaikelly]

Buyer beware for any foreigners that come to this medical hub for treatment. If ever they had to file a malpractice suit against a Thai hospital or doctor they are going to be sorely disappointed. Unlike Western countries where medical professionals actually have insurance policies worth more than a few baht.

Good point. That is one of the major reasons care is cheaper in Thailand (the doctors don't have to spend millions on mal practice insurance). So us old guys have a choice. Die of the disease because we can't afford the best care in the West or die of an error in treatment in Thailand. Same thing happened to me in Rayong and Tampa. In Tampa I spent $36,000 for three hours in the ER and in Rayong $3000 for three days in the hospital. All things considered if they screw up and I die while on the operating table in Thailand, who cares. My last memory will be of good looking nurses in short skirts and high heels. Mal practice insurance Florida OB/GYNs liability coverage to $200,000 US dollars per year.

[coma]

Maybe with the minimum wage increase they will be able to afford the services of the " medical hub ".

[seaeagle]

Perhaps the government should start paying their regular doctors a salary commensurate with their training, rather than blaming them for pursuing a higher salary in the private sector. A good friend needed to open his own practice to make ends imeet, while working in a government hospital. The problem with AEC, for Thailand is that it really opens the market to competition.

Sadly, you're wrong I think. Certain I've read that doctors can come here to practice medicine after AEC, but that they have to be proficient in Thai language to do so.

Now, is this not in-built protectionism to ensure that few doctors qualify for this??

[stoli]

"According to a Health Ministry report, Thailand has 43,424 physicians working at public and private hospitals across the country. To provide adequate services, that figure needs to be doubled. The "2011 World Health Statistics" report by the World Health Organisation showed that in Thailand there are just three physicians for every 10,000 patients, compared to 18.3 in Singapore, 9.4 in Malaysia, 11.5 in the Philippines and 12.2 in Vietnam. In Norway, the United Kingdom and US, the ratios were 42, 27 and 24."

Some interesting statistics here and show precisely why one has to aim off for a complete day at a public hospital for even a minor call. Equally at the smarter private hospitals, although the waiting is much less, the number of people (Thais and foreigners) attending them seems to be increasing, almost by the week, in spite of the burgeoning cost of these hospitals. Three physicians per thousand patients is an appalling ratio and scarcely gives Thailand the right to claim itself as a 'medical hub'.

Unlike established foreign countries that you cite, in Thailand how many people are Doctor's of Philosphy, Music, Economics, Weather, Literature, even Automotive Design? And the list just goes on. Now, compare just Medical Doctors and impress me with that list please.

[chiangmaikelly]

I was thinking about this and my grandfather. My grandfather only saw a doctor once in his life and that was when he died at 84. I think a lot of Thai people are like my grandfather. About half I would say. That leaves around 30,000,000 people. Of those at least 10,000,000 are young and healthy and never go to a doctor. 20 million left. Of those 20 million half go to the pharmacy for every ill and never see a doctor. So that leaves 10 million people and 43,424 doctors. That is one doctor for every 230 people. Not too shabby and the reason you never have to wait more than 20 minutes to get treatment at a clinic.

[rubl]

After the positive twisting of numbers to reach a conclusion desired, let's go back to reality of THAI people 'only' paying 30 Baht and getting shabby service, waiting all day in hospitals or clinics.

Anyone with money gets better treatment of course and from posts here I gather foreigners are happy.

[chiangmaikelly]

After the positive twisting of numbers to reach a conclusion desired, let's go back to reality of THAI people 'only' paying 30 Baht and getting shabby service, waiting all day in hospitals or clinics.

Anyone with money gets better treatment of course and from posts here I gather foreigners are happy.

That is just silly. Rubi come to Thailand and look. I go to a Thai government hospital. I go to clinics that Farang don't go to and I go to a private hospital that is 99% Thai. Waiting time at the last two are in minutes and the first an hour or so. Why are you talking about things you have no experience with?

[rubl]

After the positive twisting of numbers to reach a conclusion desired, let's go back to reality of THAI people 'only' paying 30 Baht and getting shabby service, waiting all day in hospitals or clinics.

Anyone with money gets better treatment of course and from posts here I gather foreigners are happy.

That is just silly. Rubi come to Thailand and look. I go to a Thai government hospital. I go to clinics that Farang don't go to and I go to a private hospital that is 99% Thai. Waiting time at the last two are in minutes and the first an hour or so. Why are you talking about things you have no experience with?

My dear chap, I haven't been out of Thailand since April 2002. My last visit to a Thai general hospital was in January to get a Medical Certificate. I have no personal experience with going to a hospital when really sick, I must admit. Sorry about that

Still even in Bangkok I know enough people from lower income classes who are not impressed by the service of clinics and passing them I can see the ones near my appartment are mostly full.

[chiangmaikelly]

After the positive twisting of numbers to reach a conclusion desired, let's go back to reality of THAI people 'only' paying 30 Baht and getting shabby service, waiting all day in hospitals or clinics.

Anyone with money gets better treatment of course and from posts here I gather foreigners are happy.

That is just silly. Rubi come to Thailand and look. I go to a Thai government hospital. I go to clinics that Farang don't go to and I go to a private hospital that is 99% Thai. Waiting time at the last two are in minutes and the first an hour or so. Why are you talking about things you have no experience with?

My dear chap, I haven't been out of Thailand since April 2002. My last visit to a Thai general hospital was in January to get a Medical Certificate. I have no personal experience with going to a hospital when really sick, I must admit. Sorry about that

Still even in Bangkok I know enough people from lower income classes who are not impressed by the service of clinics and passing them I can see the ones near my appartment are mostly full.

Then you know there is ever only a short wait at most clinics. The better the doctor the longer the wait but for every busy clinic there are 4 slow ones close by. You also should know that employed Thais are on a different health care plan than the poor farmers and hospitals are good and the wait minimal. Teachers and all government workers are on a better health care plan than the 30 baht deal and you should know that. Speak the truth. If you hang around unemployed farmers you will get a far different experience than the average educated employed Thai person. I don't know any dirt poor farmers so I leave that to others to comment. However the people I see in Hospitals are well taken care of and with no long waits.