Thai Health Ministry To Set New Rate For State Doctors

[webfact]

MEDICAL ALLOWANCE
Ministry to set new rate for state doctors
PONGPHON SARNSAMAK
THE NATION

Stipend to be based on number of patients, instead of remoteness of area

BANGKOK: -- Medical workers under the Public Health Ministry were up in arms after the state decided to reset their allowance rate.

The allowance currently paid to medical workers depends on how remote the area under their jurisdiction is, while the new rate will be based on how many patients they serve.

The new rate will be implemented from April 1.

"Medical workers who work |hard deserve to be paid more," Public Health Ministry's permanent |secretary, Dr Narong Sahamethapat, said.

NEW RATE TO BE LAUNCHED IN 10 HOSPITALS FIRST

According to Narong, some 10 provincial hospitals such as the one in Nakhon Ratchasima province's Sung Noen district and Chachoengsao's Phanom Sarakham district will start paying the new rate, while the remaining hospitals will be given three months to review the new allowance.

The Association of Hospital Pharmacy also wrote to Narong yesterday to voice its full support for the new rate.

Pratin Huengwattanakul, a pharmacist at Phra Nang Klao Hospital who led a group of other hospital pharmacists, said basing the allowance on the area where people worked was not fair.

"Some medical workers are being paid a higher allowance even if the area they work at is no longer remote," he said.

However, he suggested that the ministry set clear regulations, such as basing the rate on performance, risks and knowledge.

SCHEME 'NOT FAIR' TO RURAL DOCTORS

The Rural Doctor's Society, meanwhile, is strongly opposing the plan.

Dr Arak Wongworachart, |director of the hospital in Nakhon Si Thammarat Sichon district, said the new plan was not fair to |doctors who worked in rural areas, adding that if the ministry went ahead with this new rate more doctors would quit provincial hospitals to work in private outfits.

He added that the network would rally outside Government House on Monday to demand that Prime Minister Yingluck Shinawatra remove Public Health Minister Pradit Sinthawanarong from his post.

The protesters will also hold a mock funeral as a symbolic protest against Pradit's decision.

-- The Nation 2013-03-23

[Locationthailand]

Another brilliant Minister of PTP to receive a protest. But let's analyse the situation. Rather than paying a remote allowance - standard anywhere globally, it will be on throughput of patients. So if the good Doc can ferret enough time, say 10 minutes per patient he gets six an hour. If he tries to push through in say seven minutes he gets paid more but does the patient get correct analysis, diagnosis and prescriptions? Hardly. But no wonder the Pharmaceutical whacko's endorse the move. More they push the patients the more drugs they sell. It's always about the money and not the care of the people or the workers. I'd demand this incompetent Minister's resignation too.

[Pib]

Seems the latest proposal is akin to paying doctors based on "medical factory piece work."

Gosh, most Thai doctors now process patients like a factory assembly line especially at govt hospital clinics. For example, my MIL uses the 30 baht medical program coverage and sees a particular Orthopedic doctor at a govt hospital every 3 or 4 months for a checkup and meds. He's an very good doctor and surgeon...did a great job in doing her lower back surgery several years ago.

Anyway, during the MIL's visit to the hospital orthopedic clinic there are always many patients waiting to be seen...and they are processed through the doctor's office about every 3 minutes...a person getting 5 or more minutes with the doc is extremely unusual. The patients set in the packed waiting room just outside his little office and usually 4-6 people are in this office which are the very next patients in line to be seen. Basically, when you actually see/get to talk to the doctor is by being able to set in the chair directly in front of his desk while the other folks next to be seen are setting in the other chairs in the office only a few feet away...able to hear the whole doctor-patient conversation. Wish I could say this is "not" the norm at many hospital clinics, especially in the provinces, but over the years I've been in enough hospitals with family/friends to know it's probably the norm.

Paying the doctors based on "quantity seen" should probably be "a factor" in what doctors get paid but it shouldn't be the only factor as it pressures doctors to see more patients which will probably just cut down those 3 minute consultations to 2 minute consolations and give little incentive to providing medical care in remote, low population areas.

[unanimosity]

Expect to see rural docs seeing everybody in town several times a month and offering phone-in consultations. They will find a way to get the numbers and payments up. "Everybody with a headache in room 2, those with stomach problems please go into room 3, and those with STDs please wait a moment as we are trying to locate a room large enough."

[tigermonkey]

I really don't see why this has become 'an either or choice'. Thailand has been quite well served, for some time, by giving a remote allowance to physicians. Yes, the system needs some fine tuning but to scrap it entirely is insane.

Further, physicians who work more should get paid for that work,, but not up to infinity. The earnings must be capped on a monthly basis to avoid profiteering, and the concident reduction of service quality.

There is absolutely, no reaason to not have a sysyem combining both methods.

All of that being said, nothing is being done to address the problem in many rural areas where the doctors are not civll servants, but merely casual rated workers.

[stoli]

Another brilliant Minister of PTP to receive a protest. But let's analyse the situation. Rather than paying a remote allowance - standard anywhere globally, it will be on throughput of patients. So if the good Doc can ferret enough time, say 10 minutes per patient he gets six an hour. If he tries to push through in say seven minutes he gets paid more but does the patient get correct analysis, diagnosis and prescriptions? Hardly. But no wonder the Pharmaceutical whacko's endorse the move. More they push the patients the more drugs they sell. It's always about the money and not the care of the people or the workers. I'd demand this incompetent Minister's resignation too.

I would be hesitant with the term that paying a remote allowance is used globally. The U.S. does not have a government paid health care system. Where you set up your practice is your business, because you are working for yourself, a Dr;'s group, or for a mostly private hospital. There are some government hospitals for the poor, but like here, you would not want to have surgery done in a Government hospital..

[stoli]

Seems the latest proposal is akin to paying doctors based on "medical factory piece work."

Gosh, most Thai doctors now process patients like a factory assembly line especially at govt hospital clinics. For example, my MIL uses the 30 baht medical program coverage and sees a particular Orthopedic doctor at a govt hospital every 3 or 4 months for a checkup and meds. He's an very good doctor and surgeon...did a great job in doing her lower back surgery several years ago.

Anyway, during the MIL's visit to the hospital orthopedic clinic there are always many patients waiting to be seen...and they are processed through the doctor's office about every 3 minutes...a person getting 5 or more minutes with the doc is extremely unusual. The patients set in the packed waiting room just outside his little office and usually 4-6 people are in this office which are the very next patients in line to be seen. Basically, when you actually see/get to talk to the doctor is by being able to set in the chair directly in front of his desk while the other folks next to be seen are setting in the other chairs in the office only a few feet away...able to hear the whole doctor-patient conversation. Wish I could say this is "not" the norm at many hospital clinics, especially in the provinces, but over the years I've been in enough hospitals with family/friends to know it's probably the norm.

Paying the doctors based on "quantity seen" should probably be "a factor" in what doctors get paid but it shouldn't be the only factor as it pressures doctors to see more patients which will probably just cut down those 3 minute consultations to 2 minute consolations and give little incentive to providing medical care in remote, low population areas.

Your desrcitption fits on how it works at Banglamung Hosptial. There are no secrets as to why you are there. The whole rooom knows. I still feel that paying by quantity does not mean the doctor is doing more work. If your shift is 8 hours, it is 8 hours. 50 patients seen, 200 patients seen, that doctor is still working the same hours. Why differiente their pay? Assembly line is not the way to run a hospital anyways. Patient care is. But at least here you will always be seen.

[belg]

thailand, that is that country where a doctor will prescribe you allways medicine you dont need, that doctors in the west already know for 10-20 years that antibiotics for a cold is not a solution but a cause of resistance ...

my visits to hospitals here : many thousands bahts per visit, because my insurance don't repay outpatient doctor's visits and medicines, every farang pays, and every thai signs a paper and pays... nothing

[comserve]

At this rate the Thai medical system will be very like the English NHS except in the UK the patients have to see a particular doctor based on which side of the street you live. In the Thai system, at least the patient has some freedom of choice as to which doctor they see!!

[lemoncake]

Well its a no win situation.

If paid by location, doctors really have no incentive to work as they get paid regardless.

If paid by the person, they will try to see as many as possible to get paid as much as possible

[Andre0720]

Another brilliant Minister of PTP to receive a protest. But let's analyse the situation. Rather than paying a remote allowance - standard anywhere globally, it will be on throughput of patients. So if the good Doc can ferret enough time, say 10 minutes per patient he gets six an hour. If he tries to push through in say seven minutes he gets paid more but does the patient get correct analysis, diagnosis and prescriptions? Hardly. But no wonder the Pharmaceutical whacko's endorse the move. More they push the patients the more drugs they sell. It's always about the money and not the care of the people or the workers. I'd demand this incompetent Minister's resignation too.

The doctor I visit in Phuket will see some 30 patients per hour, or more.

I just love it.

He is smart. I always agree with his diagnosis.

Some poeple leaving his cabinet just praise him before they leave.

He does his best to not overmedicate.

I spend one or two minutes in his office, and I NEVER feel I should be there longer.

And I am still alive.

And I suggest to everyone I know back home to propose the same approach to medicare as here.

Back home, the biggest impediment to health care is called 'The college of Physicians and Surgeons'.

When I talk to my doctor back home, he tells me to slow down. When I ask why, he tells me he has to takes notes for the College. I am paying, but I am not the boss. The College, in its great stupid wisdom, is calling the shots.

That College has to go.....

[Locationthailand]

At this rate the Thai medical system will be very like the English NHS except in the UK the patients have to see a particular doctor based on which side of the street you live. In the Thai system, at least the patient has some freedom of choice as to which doctor they see!!

Sadly if you hold a Social Security Card and wish to use a doctor you go where the card says - you do not have the choice if you want the 30 Baht system, which is the majority of the people these days. Expats can pick and choose, hi-so Thai's can as well, but not the populace at large.

[Locationthailand]

Another brilliant Minister of PTP to receive a protest. But let's analyse the situation. Rather than paying a remote allowance - standard anywhere globally, it will be on throughput of patients. So if the good Doc can ferret enough time, say 10 minutes per patient he gets six an hour. If he tries to push through in say seven minutes he gets paid more but does the patient get correct analysis, diagnosis and prescriptions? Hardly. But no wonder the Pharmaceutical whacko's endorse the move. More they push the patients the more drugs they sell. It's always about the money and not the care of the people or the workers. I'd demand this incompetent Minister's resignation too.

I would be hesitant with the term that paying a remote allowance is used globally. The U.S. does not have a government paid health care system. Where you set up your practice is your business, because you are working for yourself, a Dr;'s group, or for a mostly private hospital. There are some government hospitals for the poor, but like here, you would not want to have surgery done in a Government hospital..

Graduate doctors who do not have the wherewithall or financial means, take remote postings i.e. posting away from the place of residence, to log hours and build a bank. It is common throughout the western world if you care to check. In parts of Australia they certainly pay an additional allowance for practitioners to come to live in remote areas where quite often the doc does not have the luxury of his specialty studies such as gynecology, thus becomes a GP (General Practitioner). I have experienced the same in places like Nebraska, Idaho as well. European medical is well paid no matter where they hang their shingle so yes, a lesser 'remote' use of the word. But many are paid to be away from their principle choice of residence.