Rural Thai Doctors Accept Revised P4P Scheme

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HEALTHCARE ROW
Both sides reach a compromise
PONGPHON SARNSAMAK
THE NATION

Rural doctors accept revised P4P scheme

BANGKOK: -- PM's secretary-general Suranand Vejjajiva presides over a meeting to discuss the pay-for-performance policy at Government House yesterday. The meeting was arranged to diffuse conflicts between the Rural Doctors' Society and Public Health Minister Pradit Sinthawanarong.

The Public Health Ministry and the Network for Justice in Health System, which includes the Rural Doctors' Society, finally came to an agreement yesterday in relation to the pay-for-performance (P4P) scheme and the planned health-system reforms.

The long-standing conflict ended yesterday with a resolution to go ahead with an adjusted P4P scheme, which will be implemented fully by October 1.

Also, the Rural Doctors' Society decided to no longer push for the sacking of Public Health Minister Pradit Sinthawanarong, leaving the issue in the hands of the prime minister.

The six-month-long row had been sparked by Pradit's policy to reform the country's healthcare system and improve efficiency by implementing the P4P scheme.

Under this scheme, physicians, dentists, pharmacists and nurses will be paid an additional allowance based on the number of patients they attend to. Unfortunately, this scheme will end up cutting the monthly earnings of medical officials working in remote areas as their allowances were previously based on the location of their workplace and the number of years spent in the job.

Now it has been decided, that the P4P will be implemented in two phases.

The first phase, starting from April 1, will divide rural areas into four categories: urban community, town area and specific areas 1 and 2.

While doctors in the two latter categories will continue getting the previous "remote area" allowance, those in the other two categories will have their allowance reduced. For instance, physicians who have been serving for four to 10 years in town areas and currently earn an allowance of Bt12,000 to Bt20,000 may suffer a Bt5,000 cut.

The second phase, which will be implemented on October 1, will see medical staff serving in urban community areas being paid their allowances based on the P4P system.

After four hours at the roundtable yesterday, both sides also agreed to set up a committee to revise the P4P system, the first phase of which has been implemented since April 1 and has already affected some state hospitals in rural and remote areas.

This committee will comprise representatives from general, central and rural hospitals.

The panel, to be chaired by Fiscal Policy Research Institution Kanit Saengsuphan, has up to two months to study how the P4P can be adjusted to reflect real conditions.

At the meeting, the two sides agreed to compensate those who have unfairly lost out on their allowance as well as adjust the status of each rural hospital after finding that many of the rural areas have been developed.

Pradit has also said the ministry will hold a workshop on the implementation of the P4P scheme for hospitals nationwide.

"The P4P has to be implemented by all hospitals after October 1. Nobody can oppose the plan and if it is not implemented, no allowances will be paid," he said.

Meanwhile, Rural Doctors' Society president Kriangsak Watcharanukulkiat said he was happy with the resolution, but still wanted the Public Health Ministry to implement the additional allowances based on location and years of service. He added that though he would personally prefer Pradit's sacking, his group has submitted a petition to Prime Minister Yingluck Shinawatra.

"It now depends on her," he said, adding that the network will not drop the plan to hold a huge rally outside Yingluck's home until they see a Cabinet resolution on changes to the P4P scheme.

Box: Resolution

P4P scheme to be revised;

No co-payment in the National Health Security Fund's universal healthcare scheme;

A study will be conducted to evaluate the existing Bt30 healthcare scheme;

Government Pharmaceutical Organisation (GPO) will not be privatised;

The National Health Security Office, which works as a medical-service purchaser, will not be merged with the Public Health Ministry;

An independent team will be set up to study the sacking of GPO's former managing director Dr Witit Artavatkun.


-- The Nation 2013-06-07