Eliminating the Undead in Healthcare Sector
A Struggling Giant: Thailand's Public Healthcare System Under Strain
The internet erupted last month when a picture surfaced of a dental unit at Tanao Sri Hospital, a remote community hospital in Ratchaburi province, using a frog-hunting headlamp instead of a suitable dental lamp. This incident underscores a grim reality: Thailand's public healthcare system is reeling.
Tanao Sri Hospital, a hospital near the Thai-Myanmar border, has grappled with equipment scarcity for three years, as their plea for new equipment remained unanswered. It was only after public uproar on social media that the Ministry of Public Health urgently approved the budget allocation.
While Tanao Sri's story may have had a positive conclusion, many other state-run hospitals continue to face a crisis, experts warn.
Dwindling Resources and Financial Woes
The Ministry of Public Health disclosed that revenue from healthcare service charges across the network of public hospitals has plummeted drastically. From 60 billion baht to 40.6 billion baht this fiscal year, the drop represents a 9.5% decline. At least four major hospitals nationwide find themselves in a severe financial predicament, requiring immediate financial assistance to function.
A Mass Exodus of Healthcare Workers
The issues plaguing the healthcare system go beyond finances, says Chutinart Chinudomporn, coordinator of the Thai Frontline Physician Union. In the northeastern province of Bueng Kan, she reports that 18 intern doctors abandoned their posts at Bueng Kan Hospital.
Chutinart describes the work environment at state hospitals as gloomy and soul-sapping, with immense workloads, poor work-life balance, organizational injustice, and dim pay. Many doctors work up to 100 hours per week, double the 45-hour limit stipulated under labor law, primarily due to high patient volumes under Thailand's 30-baht universal healthcare scheme.
Without immediate structural reforms, more healthcare professionals are expected to resign, Chutinart warns, and ultimately, patients will suffer the consequences. Longer wait times for medical care are already on the rise due to staff shortages.
From 2013 to 2022, an average of 455 doctors left the public sector each year. With about 24,000 doctors under the ministry, one doctor serves approximately 2,000 people – double the World Health Organization's recommended ratio, Chutinart says.
Though the ministry is working to increase the number of doctors, Chutinart maintains this approach fails to address the core issue. Larger-scale system reform is essential, she suggests, to foster fairness and justice across medical fields. "Without a nurturing work environment," she explains, "few will choose to stay."
Starker Salaries for Nurses
Nurses confront similar challenges, says Suwimol Namkanisorn, co-founder of Nurses Connect, an association of nursing professionals. Each year, over 7,000 nurses leave state hospitals, with many seeking employment in private hospitals or changing careers. Many nurses and support staff receive inadequate wages, with some, particularly support staff, earning wages far below the minimum wage specified by law.
True reform in healthcare requires focus on nurses and other staff, Ms. Suwimol argues, not just resolutions for doctors alone.
Paralyzed Bureaucracy
Ms. Suwimol also highlights the limited budget flexibility at state hospitals, suggesting allowing the Ministry of Public Health to operate independently from the Office of the Civil Service Commission could improve management flexibility.
A recent survey by the Medical Council of Thailand found that 84.8% of the 2,431 intern doctors at state hospitals who took part were displeased with their working conditions. Worryingly, 3.5% of respondents expressed intentions to resign even before commencing their employment.
Key factors cited included poor working environments (61.4%), unfair hierarchies (51.7%), and low wages (42.9%).
Jarauyporn Srisasalux, deputy director of the Health Systems Research Institute (HSRI), advocates for flexible employment models, outsourcing, and wage structures tied to per-head budget allocations.
Jarauyporn also proposes elevating the penalty fine for intern doctors who breach their contracts from 400,000 baht to 2.5 million baht to discourage resignations.
Another long-term solution being considered is the "autonomous hospital" model, where hospitals manage their own finances and operations independently while still receiving government support. Banphaeo General Hospital in Samut Sakhon represents a successful example of this model, having increased its income and improved staff conditions since becoming autonomous.
It is the only state hospital in Thailand that operates independently from the traditional bureaucratic system and functions as a hybrid between the government and private sectors, having been established in 2000 as part of healthcare service reform to secure conditions for a loan from the Asian Development Bank (ADB).
Sources:[1] Channel NewsAsia - Thailand's public healthcare system struggling amid COVID-19 pandemic, human resource crunch[2] World Health Organization - Thailand[3] Lancet - Fostering rural medical education in Thailand: Lessons from success[4] Health Systems Global - From reform to rebalance: Fairness in government-financed healthcare in Thailand[5] Asian Development Bank - Thailand: Improving Healthcare Outcomes for All: A Progress Report
- The incident at Tanao Sri Hospital, a remote community hospital, has exposed the financial woes faced by Thailand's public healthcare system, with revenue from healthcare service charges declining by 9.5% this fiscal year.
- Nurses, like their counterpart doctors, are also leaving state hospitals in droves due to low wages, with many seeking employment in private hospitals or other sectors.
- The exodus of healthcare workers is a growing concern, as more doctors and nurses resigning can lead to longer wait times for medical care and potentially deteriorating health-and-wellness outcomes for patients.
- Expert recommendations to alleviate these issues include structural reforms to create a nurturing work environment, flexible employment models, outsourcing, and wage structures tied to per-head budget allocations.
- Business solutions, such as the "autonomous hospital" model adopted by Banphaeo General Hospital in Samut Sakhon, have demonstrated success in increasing income and improving staff conditions while still receiving government support.
- In addition to financial and structural reforms, addressing mental health and providing education-and-self-development resources would be crucial to fostering a healthier, more sustainable workforce for Thailand's public healthcare system.
