P4P Caused Disputes At Thai Hospitals

[webfact]

PAY FOR PERFORMANCE
'P4P caused disputes at hospital'
Pongphon Sarnsamak
The Nation

Mixed response at pilot centres to new health policy

BANGKOK: -- Some urban hospitals may be able to boost efficiency by following the pay-for-performance principle to optimise workloads, but for some rural hospitals this new practice has created problems.

Dr Prasitthichai Mangchit, director of Saraburi's Kaeng Khoi Hospital, said yesterday: "We have been implementing this concept to pay an extra allowance to medical workers for three years but we found that many of them were competing and fighting each other to keep score for the allowance."

The rural hospital is one of 10 piloting pay for performance, which was introduced by the Public Health Ministry and approved in principle by the Cabinet on Tuesday in a bid to improve the efficiency of medical workers at the ministry's hospitals nationwide.

The P4P system, as it is known, bases the allowance on work results, and replaces an earlier policy based on location and the number of years worked.

The old method was aimed at retaining medical workers in rural and remote areas where doctors are in short supply.

But the ministry found some medical workers were receiving the allowance even though they did not do their job very well and spent time on other business.

The ministry's push for P4P has been strongly opposed by thousands of rural doctors and medical workers over the past few days. They see the new method as a threat to their income and claim it would destroy their motivation to work in outlying areas.

According to the Rural Doctor Society, at least 15 rural doctors and medical workers in Chiang Rai and Phayao have already resigned after they learnt that their allowances will be cut when the ministry starts the new rates on Monday.

"We told the ministry about this problem in the past few years - that this method would be a burden on the hospital, to collect data and calculate the allowances," Prasitthichai said.

Kaeng Khoi Hospital is now spending about Bt100,000 on allowances for 200 medical workers, including doctors.

The allowances range from Bt200-Bt1,000, but it is very complicated to calculate the payment for each worker as each job description is very different.

While P4P was a good idea, he thought it should be implemented gradually to allow hospitals time to adjust.

Meanwhile, Makarat Hospital in Kanchanaburi is an example of a site where P4P has succeeded.

"Each medical worker has his own assignment and knows what he has to do. They have never competed among themselves for allowances," deputy director Boontuen Poonsiri said.

The hospital has been using this method since 2008 to motivate medical staff to work at the hospital as long as they could. But it is a general hospital, so it was not eligible for the old system.

However, it spent Bt1 million of its own funds for a special budget to support allowances based on work indicators.

"If you work hard you get more allowance. If you don't work you get nothing. If everyone works together they will get the same allowance," she said.

The hospital has set up criteria based on workload to calculate the rate of allowance. Each medical profession has a specific rate. For example, dentists will get Bt7,000 if they meet the conditions but the allowances for other professionals would be more or less depending on the conditions of their job.

"We found that the quality of medical services provided to patients has improved since we implemented this concept," she said.


-- The Nation 2013-04-01

[jonclark]

Here's an idea - how about Pay for Performance (P4P) for all MP's. If they think it's such a good idea then they should embrace it themselves. I mean the parliament always has the required quorum, and MP's never vote for absent colleagues do they?

[drdoom6996]

The government has pissed the nurses off and now the doctors. Who's going to be in the State hospitals working in the next year.

[Thai at Heart]

spent time on other business

If they can't even get doctors to clock in and out on time, what hope is there?

[Locationthailand]

"... The allowances range from Bt200-Bt1,000, but it is very complicated to calculate the payment for each worker as each job description is very different."

Wow, must be genius accountants with calculators or computers who ran out of fingers and toes.

[Almera]

"We have been implementing this concept to pay an extra allowance to

medical workers for three years but we found that many of them were

competing and fighting each other to keep score for the allowance."

Thais being competitive and stabbing each other in the back, well, I am surprised, lucky they're not policemen getting different promotions or there'd be a gun massacre.

There is no hope for this country and its 'professionals', don't even bother trying.

[scorecard]

spent time on other business

If they can't even get doctors to clock in and out on time, what hope is there?

Not surprised by the 'spent time on other business', this is rampant in many Thai ministries including defense and the police.

Clearly someone didn't do their homework about the factors which are critrical to making 'pay for performance' work.

What's missing is an additional KPI about: co-operation / collaboration / teamwork / networking / relationship building - call it what you will, appropriate to the industry or profession.

[hellodolly]

"... The allowances range from Bt200-Bt1,000, but it is very complicated to calculate the payment for each worker as each job description is very different."

Wow, must be genius accountants with calculators or computers who ran out of fingers and toes.

They have sent away to China to get a team of Chinese armed with abacuses.