Upheaval In Thai Health System Over ' Pay For Performance'

[webfact]

HEALTH
Upheaval in health system
PONGPHON SARNSAMAK
THE NATION


Public Health Minister Pradit Sinthawanarong, in black jacket, and permanent secretary Dr Narong Sahametapat, in white shirt, wearing glasses, receive bouquets from doctors and public health volunteers.

BANGKOK: -- Medical workers from rural areas vow to protest today and every Tuesday over Pay for Performance until minister resigns

The newly launched concept of Pay for Performance has gone off like a bomb in the public-health system.

The rift among staff who work in cities and towns and those working in rural areas is becoming much wider than before. Today, rural medical workers will stage a major protest in front of Government House in a bid to oust Public Health Minister Pradit Sinthawanarong for proposing the new method of pay calculation.

But yesterday, more than 4,000 medical workers from town-based hospitals showed up at the Public Health Ministry to express support for Pradit. Their work zones are in towns, which deprives them of a special allowance for medical workers in rural zones. With the Pay for Performance concept, they look set to enjoy better pay for the huge workload they have long shouldered.

Although town-based medical workers have usually enjoyed access to better facilities and infrastructure, they have often tended to patients with more complicated conditions. Smaller hospitals in remote areas need to refer patients with serious symptoms to better facilities in bigger medical centres.

Pradit had expected the Pay for Performance policy to take effect from April 1 next year.

However, Rural Doctor Society chairman Kriengsak Watcharanukulkiat, vowed to oust Pradit before the method takes effect.

"The Pay for Performance method is going to ruin the country's public-health system," Kriengsak said yesterday.

He said at least 5,000 medical workers from rural areas would mass at Government House today to tell Pradit that Pay for Performance is neither good nor acceptable. Rural-based medical workers say they will stage their protest every Tuesday until Pradit bows out.

"We need to retain medical workers and medical specialists in rural areas for the sake of people in remote areas," Kriengsak said.

Medical workers in remote areas have long been entitled to a special allowance. The amount, however, was rather low during the first few decades and it was a reason why there was a severe shortage of medical workers in the rural zones for many years. But in 2008, the government offered a higher special allowance by adding up the number of years that medical workers have worked in rural areas.

Apart from doctors, nurses, dentists and pharmacists are also entitled to a special allowance.

"Pradit will drag the public health system that provided for people living in rural areas backward if he still goes ahead with his plan," Dr Suphat Ha-Suwankit said. He is the director of a state hospital in Songkhla's Chana district.

Dr Suphat said the current allowance based on remote area status encouraged many medical workers to work at rural hospitals.

"In 2008, there were just 1,000-something doctors in rural areas. Today, their number has jumped to over 4,000. Of them, 200 are medical specialists," Kriengsak pointed out.

So, he insisted that the country needed to continue with the initiative launched in 2008.

"After 21 years of work in rural areas, my special allowance, plus allowance for my medical expertise stands at around Bt30,000 a month. I don't think it's too high," Kriengsak said.

He shrugged off criticism that some old doctors hardly work now but earn payment because of the number of service years counted in the current pay-calculation. Kriengsak said just three doctors in rural areas earn more than Bt70,000 in special allowance.

"If the doctors in rural zones do not get a reasonable special allowance, many will just leave," he said. His group is gathering signatures to fight the Pay for Performance plan.

Meanwhile, Dr Prachumporn Booncharoen, president of the Thai Federation of General and Central Hospital Doctors, has already submitted 20,000 signatures to Pradit to show how many medical workers agree with the new pay-calculation method.

She insists Pay for Performance would not hurt medical services at hospitals.

"It will only encourage medical workers to work to the best of their abilities," Prachumporn said.


-- The Nation 2013-03-26

[seajae]

This should be brought in for all government positions, can you imagine the uproar if all those police, teachers, immigration, customs etc had to actually WORK to get paid, might put an end to all the EXTRA money they make from gifts. To be honest I think I would probably run off the road if I actually saw a policeman pulling someone over for doing the wrong thing and writing them out a ticket, might start a whole new way of raising funds for the country. Teachers teaching all the class(not just the ones with money) customs officers actually leaving their airconditioned office to do their job, wow, its just to much.

[belg]

my last visit in a private hospital was also for me, about 3-4 minutes as a checkup .... kajien kajien .... 2000 baht for 3 minutes

only FARANG had to pay cash or CC, thais ... FREE

and this was NOT a public gov hospital !!!

[tragickingdom]

The Thai system will be the next system in the world that will be wrecked by the pay for performance system. Once started in backward America some bean-counter got the idea that capitalist principles should rule the healthcare system too. Market conform pay is a buzzword, so the more operations the more money. Yeas waiting times will be minimized, but the money spend on healthcare will balloon because doctors will perform needless checks and operations. The market system can't work in healthcare. Not only don't have patients any clue what the doctor is doing, they have no power to compare. If one hospital asks 1000 baht for a scan and the other 10.000 baht and you are in the hospital or worse in the emergency room there is no power anymore. Rural doctors are spot on they are far more helped by better hospitals and a general raise than by a stupid system like this.

[moe666]

my last visit in a private hospital was also for me, about 3-4 minutes as a checkup .... kajien kajien .... 2000 baht for 3 minutes

only FARANG had to pay cash or CC, thais ... FREE

and this was NOT a public gov hospital !!!

The present system allows Thais to use a private hospital if the government hospital cannot care for them. Concerning the free treatment do you have one of the various Thai medical programs that allows you to be treated for free.

[Shurup]

...

"It will only encourage medical workers to work to the best of their abilities," Prachumporn said.

It will only encourage medical worker to rid of a patient ASAP to get to the next one, quality will suffer.

[wilgoster]

The Thai system will be the next system in the world that will be wrecked by the pay for performance system. Once started in backward America some bean-counter got the idea that capitalist principles should rule the healthcare system too. Market conform pay is a buzzword, so the more operations the more money. Yeas waiting times will be minimized, but the money spend on healthcare will balloon because doctors will perform needless checks and operations. The market system can't work in healthcare. Not only don't have patients any clue what the doctor is doing, they have no power to compare. If one hospital asks 1000 baht for a scan and the other 10.000 baht and you are in the hospital or worse in the emergency room there is no power anymore. Rural doctors are spot on they are far more helped by better hospitals and a general raise than by a stupid system like this.

Spot on, this comment.