Medical tourism worsens doctor crisis

The trend is particularly worrying because medical schools have reportedly lost some of their most valuable teachers to private medical facilities.

"If top medical experts really leave medical schools, grave damage is inflicted on the country's healthcare system. The government spends a lot of time and money to produce a capable medical expert," Dr Thinnakorn Noree said.

Thinnakorn heads the Human Resources for Health Research and Development Office.

In 2003, the government led by Thaksin Shinawatra launched a project to turn Thailand into a regional medical hub.

Thinnakorn said: "On the one hand, the project attracts about Bt50 billion each year for the country. But on the other hand, the Public Health Ministry and state authorities are worried about human resources available to them [given doctors shifting to the private sector]."

"This problem has been discussed for a long time but until now there has been no research or study established to get deep into the information."

He said Privy Councillor Kasem Wattanachai would chair the panel and convene its first meeting next Monday (Feb 11).

The exodus of doctors from the public hospitals to private hospitals has been blamed on the medical hub project, according to the ministry's study. Lower pay at state facilities plus greatly increased workloads on medical staff because of the introduction of the Bt30 health system - which caused a huge jump in the number of hospital visits - have also played a role.

However, data relating to the "brain drain" is scant. That's why the Public Health Ministry wants to conduct a study to try to gauge possible impacts from the predicament.

The first phase of the medical hub project was implemented in the five years to 2008. A sub-panel from the national health office will conduct a study to evaluate this and try to assess effects from implementation of the next phase.

The medical hub project includes three facets that aim to boost medical services such as sickness prevention, spa services and Thai massage. It also promotes Thai herbal medicine products.

A health ministry study estimates these projects have generated Bt200 billion over the past five years from medical services provided to millions of foreign patients who come to Thailand to take advantage of the lower cost of medical treatments available here.

Private hospitals in Thailand benefited most from these projects, the study found. And some private hospitals started marketing strategies based on packaged services targeted more towards foreign patients.

The relatively competitive price, high quality services and excellent hospitality contributed to a rapid influx of foreign patients.

The study forecasts that by 2015 up to eight million people will seek outpatient services here, plus 400,000 will seek medical treatment as patients in private hospitals.

Some 176 to 303 physicians will be needed to cater for this demand, which is equivalent to 23-24 per cent of the country's private doctors or 9-12 per cent of total doctors in the country.

"We expect this will draw a large amount of physicians into the private sector, and cause a shortage of medical workers in the public hospital system," Thinnakorn said.

Three trends have emerged in the exodus from the public health system:

l general specialists leaving provincial public hospitals to private hospitals;

l staff leaving public hospitals for medical schools;

l "super" specialists leaving medical schools to provide services to international patients at private hospitals.

Senior health officer Viroj Tangcharoensathient said future studies should focus on how to increase the supply of doctors and nurses needed to cope with the demand from medical tourism.

They should also review the financial and non-financial incentives for medical staff in the rural public sector in order to improve its effectiveness and sustainability.

The capacity for medical staff to work in private practice and part-time at state facilities should also be explored.

Pongphon Sarnsamak

The Nation