Rural Thai Hospitals Fear Exodus Over P4P Plan; Doctors ' Already Quitting'

[webfact]

HEALTH
Doctors 'already quitting'
Pongphon Sarnsamak
The Nation


Doctors and public health personnel based outside Bangkok who are campaigning against a new scheme which affects their payments gather outside Government House yesterday.

Rural hospitals fear exodus over P4P plan; staff in urban areas not sympathetic

BANGKOK: -- Some rural hospitals that have adopted the Pay for Performance (P4P) system have already lost some doctors, and more are expected to quit when the system is rolled out in hospitals nationwide on April 1.

"At least two doctors have told me they would quit and move to an urban location if affected by the P4P system. One of them says he would take the opportunity to go back to medical school to further his education," said Dr Dusit Khumchaiyaphum, a director of Chaiyaphum province's Ban Thaen hospital. "Both are worried about receiving lower allowances under the system."

Ban Thaen is among some 10 provincial and rural hospitals that have been using P4P since 2006. It receives about Bt40 million annually from the three national health schemes - the National Health Security, Social Security, and Civil Servant Medical Benefit schemes. Ban Thaen spends about Bt2 million of this budget on the P4P allowance.



Yesterday, rural doctors protested at Government House, demanding the abolition of the new pay system, and the resignation of Public Health Minister Pradit Sinthawanarong, who plans to enforce the system, which was conceived under the previous Democrat-led administration.

At present, the size of the rural doctors' monthly allowance is based on the remoteness of their location and their number of years in the job. But from April 1 the remoteness allowance that now covers 736 rural hospitals will shrink to cover just 122 hospitals. Meanwhile, under the new system, the allowance will expand to cover dentists, nurses and pharmacists, as well as doctors. Doctors not on duty would also be deprived of the "currently-automatic" allowance.

Pradit responds

Pradit said he would talk today with relevant parties on zoning and extra pay-rates based on principles approved by the Cabinet yesterday. According to the principle, the extra pay will be awarded in lien with the remoteness of medical workers' workplace as well as their performance.

"If representatives of relevant parties do not come, then there will be no negotiation because they have refused my invitation to the negotiation table."

He said he needed to present the conclusion on the new extra pay-rate to a vetting committee, which is chaired by Deputy Premier Kittiratt na Ranong by Friday.

"We will present it to Cabinet on March 31," he added.

Pradit said he at first planned to meet with demonstrators in front of the Government House yesterday but changed his mind. "Some demonstrators have told me that they can't guarantee my safety," he said.

Asked why a number of doctors turned up against him, Pradit said: "I don't know whether they have any ulterior motive. I think even though this pay-rate issue doesn't come up, they will still find something else to attack me."

Each year, Thailand spends Bt3 billion on the allowance for rural hospitals. At present, just three of over 2,000 doctors working at rural hospitals earn an allowance of Bt70,000. Thailand currently has about 8,000 doctors.

Health workers split

Doctors and health workers appear to be split over the move. Some in urban areas oppose the rural doctors' grievance.

Dr Prachumporn Booncharoen, president of the Thai Federation of General and Central Hospital Doctors, said: "Rural doctors have resigned all the time, many for further study and many for jobs at state hospitals. That happens regardless of the new pay-calculation system."

Dusit from Ban Thaen Hospital was one of 2,000 medical workers who joined the protest yesterday. He said Ban Thaen's 30-bed hospital only has four doctors providing medical treatment for about 200 patient a day. With two resigning, the remaining doctors' workload will double.

"We will shoulder more workload if these two doctors quit," he said.

Kanjanadit Hospital in Surat Thani faces a similar situation, as medical staff are now starting to say they will resign and go to work in the city. For five years, this hospital had only five doctors but since the number of doctors and medical workers increased when it started providing the allowance based on remoteness and working years. Now, 11 doctors work at the hospital, but they fear that changes to the allowance will make their quality of life worse.

Hospital director Dr Akachai Mukdapitak said: "Under the new concept of allowance, they don't know how much work they should do to get the same amount of allowance they are being paid. This new rate of allowance has really discouraged our medical workers."

The new pay system is part of Minister Pradit's plan to revamp the national health system, in light of increasing burden to come from health policies and the ageing population.

The Cabinet yesterday approved a budget of Bt190 billion for the National Health Security Office (NHSO), which operates the universal healthcare scheme. Bt125 billion of this goes to the scheme.


-- The Nation 2013-03-27

[smutcakes]

I presume if they did not have this part in the article ' which was conceived under the previous Democrat-led administration' this topic would already be 5 pages of Yingluck, Thaksin, PTP bashing. I just cannot understand how every thread on TVF descends into criticism of the Government, yet this one which seems prime for it with key words like 'Doctors' "rural' 'quitting' has been left untouched

[retell]

need more coffee I will be right back

[Locationthailand]

Doctors are in short supply globally as population increases. Any credentialed doctor can get work with great salaries overseas. If the Minister can't put 2 + 2 together then Thailand will lose this IP. And yes as you observe Smutcakes, this one really does deserve a bashing LOL.

[MikeOboe57]

So, a doctor who spends more time with every patient, finds the right diagnosis, administers the right treatment and gets the patient back in a healthy condition sooner, is punished with a wage cut, while the sloppy quack who takes just 3-5 minutes per patient, diagnoses on "just guessing" and "maybe" and has in consequence some of his patients back in hospital with the same illness or a worsening condition, gets rewarded although his work costs the taxpayer more money.

Amazing Thailand. Anyone who supports this idiocy deserves a kick in the groin.

[retell]

So, a doctor who spends more time with every patient, finds the right diagnosis, administers the right treatment and gets the patient back in a healthy condition sooner, is punished with a wage cut, while the sloppy quack who takes just 3-5 minutes per patient, diagnoses on "just guessing" and "maybe" and has in consequence some of his patients back in hospital with the same illness or a worsening condition, gets rewarded although his work costs the taxpayer more money.

Amazing Thailand. Anyone who supports this idiocy deserves a kick in the groin.

well the last time i was @ a government hospital in a " big " city it was like it was run by mac donalds got about 2 minutes per patient and if one dare to ask a question to the doctor they become pretty rude and just do not answer the question ,, now i will go to a much smaller city with this tiny little hospital and can say way better there at least give the patient the feeling that they are important and are willing to spent some time on a patient

[Johnnie99]

Beer, brewery, piss up, organise, couldn't ... re-arrange.

[orang37]

Note the complete absence of mention of the old "30 baht" health-care for the masses plan, which a certain person, now in Dubai, put forward when in power, as one of his populist political-base-building strategies which was one factor leading to "Red."

~o:37;

[Johnnie99]

So, a doctor who spends more time with every patient, finds the right diagnosis, administers the right treatment and gets the patient back in a healthy condition sooner, is punished with a wage cut, while the sloppy quack who takes just 3-5 minutes per patient, diagnoses on "just guessing" and "maybe" and has in consequence some of his patients back in hospital with the same illness or a worsening condition, gets rewarded although his work costs the taxpayer more money.

Amazing Thailand. Anyone who supports this idiocy deserves a kick in the groin.

well the last time i was @ a government hospital in a " big " city it was like it was run by mac donalds got about 2 minutes per patient and if one dare to ask a question to the doctor they become pretty rude and just do not answer the question ,, now i will go to a much smaller city with this tiny little hospital and can say way better there at least give the patient the feeling that they are important and are willing to spent some time on a patient

I am also a doctor, and the doctors at my large local (city) hospital are equally rude if one dares to question their 'diagnosis', or, God forbid, ask them to explain further. Cultural, sadly.

[Bob12345]

I am also a doctor, and the doctors at my large local (city) hospital are equally rude if one dares to question their 'diagnosis', or, God forbid, ask them to explain further. Cultural, sadly.

Guess there is also another side to this story; where someone who barely finished middle school is rude to someone who finished 6 years of university by telling them that they should get free medicine and a note to their employer that they can't work today because they have been coughing for a day already (better known as the common cold). Respect has to come 2 ways.

My wife is a doctor and when she was paying of her study debts upcountry she mentioned the hospital record of handling over 60 patients in an hour; most people going there couldnt sleep well last night or have been coughing a bit and that seemed to be reason enough to go to the hospital. All she had to do was tell them to come back if this lasted longer than a week, seemed like a simple job.

But she got so annoyed by the rude families of patients who kept asking stupid questions and never listened to what was being told that she moved on to a department where there is less / no family involved.

Some of her fellow students already quit working after a year or 2 by the way; some got sued when a baby died in child birth even though it was not their fault. The family knew it, but they smelled financial compensation and tried it anyways. Imagine what that does to ones motivation after studying for 6 years with working and studying 12-20 hours a day.

Problem is that most of the patients are just average Thais: try to explain to a monkey to stop eating bananas because it will kill him in the long run.

[Bob12345]

More ontopic:

This proposal will not help Thailand or the upcountry hospitals.

Most smaller government hospitals have trouble attracting doctors already and lowering their pay, or making it more uncertain, will result in many doctors moving to a hospital in Bangkok or working at, or opening, their own private hospital.

(btw they already cut benefits for doctors recently by stopping the coverage for direct family)

The people who will pay the price are the ones living upcountry who now will have to wait longer in line for a consult or get worse doctors since the better ones moved away already.

Who will win: the private hospitals who can now compete even easier for good doctors.

Guess thats what they meant when they wanted Thailand to become a medical hub; a medical hub for foreigners.

Edited March 27, 2013 by Bob12345

[RamblingSam]

The P4P scheme stinks and is disgusting. I would have thought that unless these people who are willing to put the welfare of people before what they earn, you wouldn't have anyone working outside more populated areas .... They should be seeing their earnings increase, not reduced! Whoever implemented the P4P scheme should be told to go and do this job themselves for about a year, on the pay that the P4P scheme operates.

[khunken]

So giving doctors an incentive to work in rural hospitals is not a good idea according to this 'plan'.

I hope the rural people in PTP areas realise that they're being screwed yet again by those they voted for.

[ZhouZhou]

So giving doctors an incentive to work in rural hospitals is not a good idea according to this 'plan'.

I hope the rural people in PTP areas realise that they're being screwed yet again by those they voted for.

it looks also like that there are plenty of people satisfied with the new system.

the OP states

" the system, which was conceived under the previous Democrat-led administration."

[raybal5]

So, a doctor who spends more time with every patient, finds the right diagnosis, administers the right treatment and gets the patient back in a healthy condition sooner, is punished with a wage cut, while the sloppy quack who takes just 3-5 minutes per patient, diagnoses on "just guessing" and "maybe" and has in consequence some of his patients back in hospital with the same illness or a worsening condition, gets rewarded although his work costs the taxpayer more money.

Amazing Thailand. Anyone who supports this idiocy deserves a kick in the groin.

This is how it works in most countries. The doctors who pump through the higher caseloads get paid more.

[khaowong1]

So, I see that the Doctor who has 21+ years of experience can make up to approx. $2400 a month. Wow.. The Doctors here in the US won't even come off the golf course for $2400 a month. or their Nurses.. or the lady who answers the phone at the office.

[Bob12345]

So, I see that the Doctor who has 21+ years of experience can make up to approx. $2400 a month. Wow.. The Doctors here in the US won't even come off the golf course for $2400 a month. or their Nurses.. or the lady who answers the phone at the office.

But they also cannot buy a meal for a dollar or a house for $100,000.

Wages differ per country, and there is no direct competition possible between Thai and American doctors (Thai doctors cannot work in America due to regulations).

[Mosha]

As someone who was nearly killed by one of these rural doctors. They need to be better trained, and I'm all for this P4P regardless of which administration thought it up. As it was conceived under Abhisit, I'm amazed it's even being considered. Given how other policies were over turned simply cos it wasn't DL's idea.

[stoli]

I am also a doctor, and the doctors at my large local (city) hospital are equally rude if one dares to question their 'diagnosis', or, God forbid, ask them to explain further. Cultural, sadly.

Guess there is also another side to this story; where someone who barely finished middle school is rude to someone who finished 6 years of university by telling them that they should get free medicine and a note to their employer that they can't work today because they have been coughing for a day already (better known as the common cold). Respect has to come 2 ways.

My wife is a doctor and when she was paying of her study debts upcountry she mentioned the hospital record of handling over 60 patients in an hour; most people going there couldnt sleep well last night or have been coughing a bit and that seemed to be reason enough to go to the hospital. All she had to do was tell them to come back if this lasted longer than a week, seemed like a simple job.

But she got so annoyed by the rude families of patients who kept asking stupid questions and never listened to what was being told that she moved on to a department where there is less / no family involved.

Some of her fellow students already quit working after a year or 2 by the way; some got sued when a baby died in child birth even though it was not their fault. The family knew it, but they smelled financial compensation and tried it anyways. Imagine what that does to ones motivation after studying for 6 years with working and studying 12-20 hours a day.

Problem is that most of the patients are just average Thais: try to explain to a monkey to stop eating bananas because it will kill him in the long run.

I was at BPH yesterday. They obviously just had a huge increaase in their rates, or i was billed incorrectly. The cashier did not want to explain anything. Even though she spoke English, she kept waving good-bye to me rather than answering my questions. She would probably go home and complain about "rude people asking stupid questions", when she really had an obligation to answer those questions. If I can help her lose her job, I will help in any way possbile. We pay for customer service, and we should get it. Sorry if questions from the patient or their family was annoying to your wife. She probably made the right decison to move into a dept. that did not require contact with the public. Doctors need to listen, provide assistance, and care for their patients.

[Bob12345]

We pay for customer service, and we should get it:

True at BPH, not true at upcountry local hospitals (the rate there was 30 baht, now its 0 baht). There you pay nothing just to receive the minimum amount of health care to stay alive.

And there is a difference between asking for details when you know what you are talking about, and being rude and ignorant. You probably started off with "excuse me, regarding this bill, can you please explain what this amount is and .....?". If the lady at the desk cannot explain that then you have every reason to complain.

But in reality there are not that many people who have a basic understanding of what they are talking about and can form a polite question; especially not the wounded motorcycle driver who is brought in drunk during songkran.

Doctors need to listen, provide assistance, and care for their patients.

At an expensive private hospital you can demand that, at any other hospital it is just a dream. Now imagine the new salary system where you increase your payments if you hurry up, do you think patient care will improve or get worse?

I was at BPH yesterday. They obviously just had a huge increaase in their rates, or i was billed incorrectly. The cashier did not want to explain anything. Even though she spoke English, she kept waving good-bye to me rather than answering my questions. She would probably go home and complain about "rude people asking stupid questions", when she really had an obligation to answer those questions. If I can help her lose her job, I will help in any way possbile. We pay for customer service, and we should get it. Sorry if questions from the patient or their family was annoying to your wife. She probably made the right decison to move into a dept. that did not require contact with the public. Doctors need to listen, provide assistance, and care for their patients.

Edited March 31, 2013 by Bob12345