It's time to fix Thailand's dire healthcare system

[webfact]

BURNING ISSUE
It's time to fix Thailand's dire healthcare system
CHULARAT SAENGPASSA

A CHANCE to visit a public hospital can shed light on the quality of basic healthcare services in Thailand.

BANGKOK: - In outpatient wards, nobody smiles, be they patients, their relatives, nurses or doctors. Patients and relatives are forced to play a waiting game, waiting for their files from the records room and praying they can see a doctor before service hours end.

As they wait, they have no clue when they will sit in front of a doctor. Nurses and doctors, meanwhile, are apparently under stress trying to manage time so all the patients can see a doctor.

Such noisy and stressful environments raise a few questions? What has happened to Thailand's healthcare systems? Should Thailand be pleased with the World Bank's praise of its universal-coverage healthcare scheme?

According to 2012 records, there were just four doctors per 10,000 people in Thailand. Add the unequal distribution of doctors at state compared to private hospitals and the problem is more acute.

Long queues are normal at state hospitals. The more famous the hospital, the longer the queue. Only those with enough money can skip these long queues by seeking medical services from private hospitals.

But what about the millions who don't have the money? As they waste hours waiting, the doctors are getting overwhelmed.

Academics say the risk of human error climbs when doctors have to handle long hours and rush to check patients each day. On average, each doctor at outpatient wards tends to 100 patients a day. Will the relevant authorities do anything to address this problem?

Some medical experts believe Thais in general should share the flak as they go to hospital for non-serious complaints such as a cold. But other experts have argued that Thais on average see a doctor just a few times each year. This is far below the 6.5 visits a year for people living in Organisation for Economic Cooperation and Development nations, and the 13 visits a year by South Koreans and Japanese.

As patients and doctors lament the state of the medical system, the relevant authorities need to rethink their approach. If both the service users and service providers are not happy, the system definitely needs an overhaul.

All stakeholders must come forward this time, air their concerns and explore solutions. If doctors feel they are overwhelmed with work, speak up. If patients feel the free medical services provided by the universal-coverage healthcare scheme make them feel helpless, speak up.

If someone feels a few minutes with a doctor may not be enough for a proper diagnose, speak up. If doctors feel it's nonsense for people to flock to famous hospitals out of concern that the doctors at less well-known hospitals may not be good enough, speak up.

If hospitals feel patients just don't understand the process of delivering healthcare services, or fail to accept the responsibility of taking basic care of their own health, they have to speak up.

All sides need to raise their points, and discuss issues together. Only by doing that can all sides explore solutions together and opt for practical ones.

There are so many problems with the country's healthcare system. All sides concerned must tackle them, including the National Health Security System, the Social Security Fund, the Comptroller-General's Department, the Public Health Ministry and private hospitals.

It is the duty of all stakeholders to come forward, lay their cards on the table and discuss the possibility of overhauling the system. An overhaul is needed. The faster it is done the better.

Source: http://www.nationmultimedia.com/politics/Its-time-to-fix-Thailands-dire-healthcare-system-30271664.html


-- The Nation 2015-10-27

[Strangebrew]

This term free treatment comes to mind some how Maybe if a co-payment was started less people would visit a hospital for minor ailments.

[Seastallion]

In the long run, it would be better to fix the education system first.

With educated people;

1. Fewer patients go gullibley to the hospital for minor ailments.

2. More efficient admin staff who can use modern systems.

3. Better qualified medical staff work more efficiently.

4. Forward-thinking Ministerial staff make wiser decisions.

5. More accurate diagnoses means fewer repeat visits.

[assayer]

"speak up" was used several times in the article, but, criticism is not something the Thai people do------EVER!

[maewang99]

not as depressing as the Guardian's and NYT's climate stories du jour Oct. 27, but close. has nothing to do with Thai folks being uneducated or not paying for their healthcare.

Edited October 26, 2015 by maewang99

[Pormax]

My experience with the Thai medical system is that Doctors, and I have seen a few here in private hospitals, don't listen to their patients and treat them as second class citizens.

I have a very good general medical knowledge being in the medical services for over 40 years and always believed it is important to be able to talk freely with the doctors and for them to listen.

The problem here is that they have the attitude of 'I know what's best, I know what is wrong, don't want to hear from you'

Give you an example: Had a cancerous tumour removed from my bladder in a private hosptal, reported back as told in 4 months for a check up.

My hospital notes were in front of the doctor but he could not be bothered to open the folder instead he asked my wife "what I come for today?;

Another example. I recently went to a different private hospital and believing that the more information you give to the doctor then the more chance they have of

making a correct diagnosis and treatment. As my problems gave many symptoms I wrote all this down on the computer and took it with me.

The doctor looked at this for a couple of minutes and then proceeded to ask some questions which proved he had not bothered to read it.

No examination was given and I left with a load more medicine which had not helped before, and a bill for over 2,000B.

Time waiting to see doctor 10 mins, time with doctor 4 mins, time waiting for medicine and invoice 45 mins.

The attitude of doctors need to change, patients are humans and equal to them. Without patients they are nothing.

[AlexRRR]

They haven't heard about the Australian public hospital system.

[AlexRRR]

My experience with the Thai medical system is that Doctors, and I have seen a few here in private hospitals, don't listen to their patients and treat them as second class citizens.

I have a very good general medical knowledge being in the medical services for over 40 years and always believed it is important to be able to talk freely with the doctors and for them to listen.

The problem here is that they have the attitude of 'I know what's best, I know what is wrong, don't want to hear from you'

Give you an example: Had a cancerous tumour removed from my bladder in a private hosptal, reported back as told in 4 months for a check up.

My hospital notes were in front of the doctor but he could not be bothered to open the folder instead he asked my wife "what I come for today?;

Another example. I recently went to a different private hospital and believing that the more information you give to the doctor then the more chance they have of

making a correct diagnosis and treatment. As my problems gave many symptoms I wrote all this down on the computer and took it with me.

The doctor looked at this for a couple of minutes and then proceeded to ask some questions which proved he had not bothered to read it.

No examination was given and I left with a load more medicine which had not helped before, and a bill for over 2,000B.

Time waiting to see doctor 10 mins, time with doctor 4 mins, time waiting for medicine and invoice 45 mins.

The attitude of doctors need to change, patients are humans and equal to them. Without patients they are nothing.

You need to be half dead before doctors will prescribe you drugs in AU son.

[Lunchbob]

A few have mentioned this already, but 1 major obstacle is subservience when meeting arrogant doctors. They have no discussion. Doctors do not know everything. You have to discuss and guide them. Be responsible for the vaccines and antibiotics you pump into yourselves and kids. Ask questions, discuss reasons, alternatives. I know this is difficult, maybe impossible other than very long term.

[ezzra]

Doctors in Thailand consider themselves as elitist and above the rest of the minions, with almost

no fear of being sued for malpractice, and if they were sued, it will be only for peanuts, they behave

with disdain and operate without fear or reprisal, that will never change, not any time soon any way,

The way to fix the health system is like it was suggested here, co payment, do away with the notions that

Thai people are poor, and the ridiculous 30 baht scheme is a joke, levy a fair payment for treatment

where by hospital will make money and treat patients with dignity....

[AlexRRR]

This term free treatment comes to mind some how Maybe if a co-payment was started less people would visit a hospital for minor ailments.

Oh the last Aussie prime minster and his treasurer wanted to introduce a co payment on doctors visits, Abbot is no longer prime minister and his treasurer soon shall no longer be in parliament.

Not popular ideology once you have something you can't take it away without serious repercussions.

How about encouraging people to adopt a healthier life style.....the need for medical will decrease, in AU once they saw what smoking related illnesses were costing the government raised taxes on tobacco to the point where it hurts, as well as run advertising campaigns and legislating for packets of cigarettes to have gruesome pictures plastered on the front, legislated for smoke bans in areas where people congregate and where food is served.

Typical western thought is to fix whats wrong rather than keep it serviced to avoid it going wrong.

[gk10002000]

Please don't follow the USA Obamacare example

[AlexRRR]

Doctors in Thailand consider themselves as elitist and above the rest of the minions, with almost

no fear of being sued for malpractice, and if they were sued, it will be only for peanuts, they behave

with disdain and operate without fear or reprisal, that will never change, not any time soon any way,

The way to fix the health system is like it was suggested here, co payment, do away with the notions that

Thai people are poor, and the ridiculous 30 baht scheme is a joke, levy a fair payment for treatment

where by hospital will make money and treat patients with dignity....

Your out of touch with reality because you have a bigger bank account than the average Thai...They tried that in AU mate and they killed it stone dead.

[ChrisY1]

Doesn't sound dissimilar to some of Australia' publc hospitals.......

Actually it's similar in many countires public systems.......

[ChrisY1]

My experience with the Thai medical system is that Doctors, and I have seen a few here in private hospitals, don't listen to their patients and treat them as second class citizens.

I have a very good general medical knowledge being in the medical services for over 40 years and always believed it is important to be able to talk freely with the doctors and for them to listen.

The problem here is that they have the attitude of 'I know what's best, I know what is wrong, don't want to hear from you'

Give you an example: Had a cancerous tumour removed from my bladder in a private hosptal, reported back as told in 4 months for a check up.

My hospital notes were in front of the doctor but he could not be bothered to open the folder instead he asked my wife "what I come for today?;

Another example. I recently went to a different private hospital and believing that the more information you give to the doctor then the more chance they have of

making a correct diagnosis and treatment. As my problems gave many symptoms I wrote all this down on the computer and took it with me.

The doctor looked at this for a couple of minutes and then proceeded to ask some questions which proved he had not bothered to read it.

No examination was given and I left with a load more medicine which had not helped before, and a bill for over 2,000B.

Time waiting to see doctor 10 mins, time with doctor 4 mins, time waiting for medicine and invoice 45 mins.

The attitude of doctors need to change, patients are humans and equal to them. Without patients they are nothing.

On the contrary, my experiences to date (12 years) have been excellent....at both private and public hospitals......a shoulder reconstruction at Rama turned out better than expected....GPs and Specialists were all very good.

But agree....we do tend to piled up with medications when we leave:)

[trogers]

In the long run, it would be better to fix the education system first.

With educated people;

1. Fewer patients go gullibley to the hospital for minor ailments.

2. More efficient admin staff who can use modern systems.

3. Better qualified medical staff work more efficiently.

4. Forward-thinking Ministerial staff make wiser decisions.

5. More accurate diagnoses means fewer repeat visits.

Forward thinking? Let's start with thinking about the present - safety helmet, safety belt, speeding and your first alcoholic drink...

[Searat7]

My experience with the Thai medical system is that Doctors, and I have seen a few here in private hospitals, don't listen to their patients and treat them as second class citizens.

I have a very good general medical knowledge being in the medical services for over 40 years and always believed it is important to be able to talk freely with the doctors and for them to listen.

The problem here is that they have the attitude of 'I know what's best, I know what is wrong, don't want to hear from you'

Give you an example: Had a cancerous tumour removed from my bladder in a private hosptal, reported back as told in 4 months for a check up.

My hospital notes were in front of the doctor but he could not be bothered to open the folder instead he asked my wife "what I come for today?;

Another example. I recently went to a different private hospital and believing that the more information you give to the doctor then the more chance they have of

making a correct diagnosis and treatment. As my problems gave many symptoms I wrote all this down on the computer and took it with me.

The doctor looked at this for a couple of minutes and then proceeded to ask some questions which proved he had not bothered to read it.

No examination was given and I left with a load more medicine which had not helped before, and a bill for over 2,000B.

Time waiting to see doctor 10 mins, time with doctor 4 mins, time waiting for medicine and invoice 45 mins.

The attitude of doctors need to change, patients are humans and equal to them. Without patients they are nothing.

I find the diagnostic skills here to be lacking. If I know what is wrong with me I get good care but if it's left to the doctor the outcome is questionable. Every year I get a complete physical here at a private hospital and bring back the test results to my doctor in USA so that we can discuss.

[mydee]

This term free treatment comes to mind some how Maybe if a co-payment was started less people would visit a hospital for minor ailments.

Oh the last Aussie prime minster and his treasurer wanted to introduce a co payment on doctors visits, Abbot is no longer prime minister and his treasurer soon shall no longer be in parliament.

Not popular ideology once you have something you can't take it away without serious repercussions.

How about encouraging people to adopt a healthier life style.....the need for medical will decrease, in AU once they saw what smoking related illnesses were costing the government raised taxes on tobacco to the point where it hurts, as well as run advertising campaigns and legislating for packets of cigarettes to have gruesome pictures plastered on the front, legislated for smoke bans in areas where people congregate and where food is served.

Typical western thought is to fix whats wrong rather than keep it serviced to avoid it going wrong.

Except the Australian medical system isn't free Is It? Taxpayers get levied 1.5-2'5% of their income in the form of the Medicare levy each year

[dageurreotype]

My experience with the Thai medical system is that Doctors, and I have seen a few here in private hospitals, don't listen to their patients and treat them as second class citizens.

I have a very good general medical knowledge being in the medical services for over 40 years and always believed it is important to be able to talk freely with the doctors and for them to listen.

The problem here is that they have the attitude of 'I know what's best, I know what is wrong, don't want to hear from you'

Give you an example: Had a cancerous tumour removed from my bladder in a private hosptal, reported back as told in 4 months for a check up.

My hospital notes were in front of the doctor but he could not be bothered to open the folder instead he asked my wife "what I come for today?;

Another example. I recently went to a different private hospital and believing that the more information you give to the doctor then the more chance they have of

making a correct diagnosis and treatment. As my problems gave many symptoms I wrote all this down on the computer and took it with me.

The doctor looked at this for a couple of minutes and then proceeded to ask some questions which proved he had not bothered to read it.

No examination was given and I left with a load more medicine which had not helped before, and a bill for over 2,000B.

Time waiting to see doctor 10 mins, time with doctor 4 mins, time waiting for medicine and invoice 45 mins.

The attitude of doctors need to change, patients are humans and equal to them. Without patients they are nothing.

I find the diagnostic skills here to be lacking. If I know what is wrong with me I get good care but if it's left to the doctor the outcome is questionable. Every year I get a complete physical here at a private hospital and bring back the test results to my doctor in USA so that we can discuss.

And your post is a typical example of the chasm between those who have the education/wealth to be able to do just that, the majority of Thais most certainly don't have either. Get a clue. Christ ..

[Briggsy]

Note the article skips neatly around the quality of doctors and the service they provide.

This is one of the major problems. There is no oversight of the medical care that doctors provide here. The review process is non-existent and the disciplinary process is virtually impossible for outsiders to complaint to and access.

The result is cursory examination, misdiagnoses, over prescribing and mis-prescribing of antibiotics, painkillers, anti-inflammatories, unnecessary tests, particularly those using expensive imported machines, intimidation threats to the objectivity of diagnoses from hospital managers, unnecessary cost and worse outcomes for patients.

Any process that is not subject to auditing and review by outside bodies will suffer from poor performance whilst simultaneously being bent to the interests of those inside the system.

[Thaidream]

The posters are correct about the arrogance of Thai doctors. You ask them a question and they feel somehow you have questioned their standing. They do not know how to really deal with the human side of medicine. The system is overwhelmed Health care for a population needs to be a human right and no one should ever make a profit from the misery of others. the Insurance industry should be banned from anything to do with medical care. The way you pay for it is a tax on earned income for those that are working. Those unemployed or the elderly get free medical care paid by the Government. Obama had an opportunity to do this and he caved into the Insurance Industry and Big Pharma. Japan uses the system I described and it works well. All medical prices are fixed and the cost well known. There are few malpractice suits as disputed cases go to a review board.

[Suradit69]

In the long run, it would be better to fix the education system first.

With educated people;

1. Fewer patients go gullibley to the hospital for minor ailments.

2. More efficient admin staff who can use modern systems.

3. Better qualified medical staff work more efficiently.

4. Forward-thinking Ministerial staff make wiser decisions.

5. More accurate diagnoses means fewer repeat visits.

" Fewer patients go gullibley [sic] to the hospital for minor ailments."

Certainly wouldn't look to the NHS in UK as a model for improvement. People there seem to use A&E services for every trivial thing as well.

Accident and Emergency departments have had their worst performance in a decade according to new official figures.

Statistics from all NHS hospital trusts show that in the last three months, 92.6 per cent of patients were seen within four hours.

It is the worst figure since records started in 2004. Until now the worst quarterly performance was in spring 2013.

The new figures from NHS England show record numbers of patients enduring long trolley waits.

In the two weeks over Christmas, 20,962 Accident and Emergency patients waited up to 12 hours on trolleys – almost four times as many as the 5,573 over the same period last year.

http://www.telegraph.co.uk/news/uknews/11327043/AandE-crisis-NHS-posts-worst-waiting-time-figures-in-a-decade.html

[humqdpf]

Clearly the author does not understand what a "dire" public healthcare system is. Waiting is a feature of any system that is provided for free - try the NHS in Britain, for instance - and as some other contributors have pointed out, if there is little provision of local clinic or general practitioner as part of a free public system, it is no surprise that everyone with a twinge will go to the hospital and create needless congestion.

I work with hospitals in less developed countries where there is little or no equipment at times, where some of the clinical staff are seriously underqualified for what they are doing, where patients are lying on floors due to lack of beds etc. Compare the Thai public health service to that available in neighbouring countries (eg Laos and Cambodia) and tell me afterwards which one is dire! Or head to certain African countries - not all African public hospitals are in a bad state but many are terrible.

The Thai system may be inconvenient, burdened with delays, overworked doctors etc. But you can still get an Xray, diagnosis and a likely cure.

[MaeJoMTB]

My children and Mil use the state health care system.

Sure, you have to wait, but it's never caused a problem.

Longest wait was about 1/2 a day, but in an emergency no wait at all.

Mil has liver problems (induced by liver flukes), high blood pressure and diabetes, goes at least once a month.

As for quality of the doctors, never had a problem, when they get it wrong I tell them to try again or just go to another hospital.

They get it right 60-70% of the time.

Much better than the UK, where you can die waiting to get a hospital appointment.

Edited October 27, 2015 by MaeJoMTB

[MaeJoMTB]

A few have mentioned this already, but 1 major obstacle is subservience when meeting arrogant doctors. They have no discussion. Doctors do not know everything. You have to discuss and guide them. Be responsible for the vaccines and antibiotics you pump into yourselves and kids. Ask questions, discuss reasons, alternatives. I know this is difficult, maybe impossible other than very long term.

You have no choice with childrens vaccines in Thailand.

They take them, or they don't attend school.

If you refuse a vaccine for the kid, they often make some excuse to get you out of sight, then inject it anyway.

[bazza40]

My children and Mil use the state health care system.

Sure, you have to wait, but it's never caused a problem.

Longest wait was about 1/2 a day, but in an emergency no wait at all.

Mil has liver problems (induced by liver flukes), high blood pressure and diabetes, goes at least once a month.

As for quality of the doctors, never had a problem, when they get it wrong I tell them to try again or just go to another hospital.

They get it right 60-70% of the time.

Much better than the UK, where you can die waiting to get a hospital appointment.

How do you know when they get it right or wrong? The patient gets better or worse? IMHO, that seems pretty tough on the patient.

I would rather find a doctor with a good reputation, although I acknowledge that's tough here too.

[Lunchbob]

A few have mentioned this already, but 1 major obstacle is subservience when meeting arrogant doctors. They have no discussion. Doctors do not know everything. You have to discuss and guide them. Be responsible for the vaccines and antibiotics you pump into yourselves and kids. Ask questions, discuss reasons, alternatives. I know this is difficult, maybe impossible other than very long term.

You have no choice with childrens vaccines in Thailand.

They take them, or they don't attend school.

If you refuse a vaccine for the kid, they often make some excuse to get you out of sight, then inject it anyway.

And very few have the courage now to question them.

[Jonmarleesco]

'Some medical experts believe Thais in general should share the flak as they go to hospital for non-serious complaints such as a cold. But other experts have argued that Thais on average see a doctor just a few times each year. This is far below the 6.5 visits a year for people living in Organisation for Economic Cooperation and Development nations ...' In the first place, all official statistics are questionable, in the second, many OECD countries operate a GP system, taking pressure off the hospitals and often permitting people to be seen away from the surgeries, as well as distorting any statistics. They also refrain from habitually prescribing antibiotics for minor ailments, thus impacting less on inbuilt immune systems and discouraging people from visiting the doctor for every little health issue.

[MaeJoMTB]

My children and Mil use the state health care system.

Sure, you have to wait, but it's never caused a problem.

Longest wait was about 1/2 a day, but in an emergency no wait at all.

Mil has liver problems (induced by liver flukes), high blood pressure and diabetes, goes at least once a month.

As for quality of the doctors, never had a problem, when they get it wrong I tell them to try again or just go to another hospital.

They get it right 60-70% of the time.

Much better than the UK, where you can die waiting to get a hospital appointment.

How do you know when they get it right or wrong? The patient gets better or worse? IMHO, that seems pretty tough on the patient.

I would rather find a doctor with a good reputation, although I acknowledge that's tough here too.

You're joking right?

You don't bother to check diagnosis yourself?

You don't have internet access?

You don't have a mind of your own?

[farangmick]

"speak up" was used several times in the article, but, criticism is not something the Thai people do------EVER!

Not to each other. They store their pent up frustrations until they can take it out on their farang husband.