'medical hub' push taking a ruinous toll on public hospitals

A well-respected economist, he is also not one to shy away from controversy.

Speaking at a seminar on the role of the mass media in public health reform organised by the Thai Journalists Association over the weekend, Ammar discussed an issue that our public health planners have always wanted to address but have been too afraid to bring to the public's attention.

Obviously many Thai doctors, particularly those employed by the government, are still torn between the traditional sense of duty to care for the sick and the poor and the modern-day necessity to make decent money.

Perhaps that's why it is a sensitive matter for members of the medical profession in the public sector who feel they are grossly underpaid to criticise their highly paid peers employed by profit-oriented private health establishments.

Ammar was not held back by such restraints. He went straight to the heart of the matter when he said that Thailand's attempt to promote itself as an international medical hub to serve foreign patients could undermine its public health system, on which the great majority of Thai people rely for their well-being.

Brain drain, or the migration of doctors from public hospitals to private healthcare establishments, which offer pay that is up to 200-300 per cent higher, was highlighted as one of a number of serious threats to the country's public health system.

Provocatively the economist then gave an example of possible solutions by suggesting that a special tax of up to 30 per cent should be imposed on foreigners seeking medical services here.

This obviously offered some food for thought and an interesting hypothesis for public debate on this important topic.

The medical hub idea is based on the supposedly win-win proposition that by persuading patients from other countries to travel to the country for medical services, thousands of well-paid jobs will be created for Thai doctors, nurses and other health workers while, at the same time, earning billions of baht's worth of hard currency for the country's economy.

The idea of making Thailand the medical hub of Asia was the brainchild of former prime minister Thaksin Shinawatra. In June 2004, the Cabinet approved a strategic plan proposed by the Public Health Ministry to persuade foreigners, particularly those from wealthier countries, and their health insurers to take advantage of medical services in Thailand, which in most cases are at least 50 per cent cheaper than in their countries of origin.

The problem is the possible adverse effects of such a scheme, especially the huge costs to the public health system, have been grossly underplayed.

The medical hub scheme is based on the assumption that Thailand has an excess healthcare capacity that can be commercially exploited without having a negative impact on the country's overall medical services, which is not true.

The idea of Thailand as a medical hub to serve foreigners could make it worse.

The Public Health Ministry has been slow to react to the looming crisis.

Only in February this year did the Public Health Ministry set up a high-level fact-finding panel to assess the impacts of the arrival of large number of foreign visitors seeking medical services on the country's public health system.

According to estimates by the Public Health Ministry, most of the benefits, to the tune of Bt200 billion over the past five years, have gone to private hospitals, while the public health system has shouldered much of the cost in terms of aggravating "brain drain" and deteriorating working conditions for government-employed doctors and nurses.

The Thaksin government's lopsided policy, in which private hospitals are promoted at the expense of the country's public health system, must be abandoned. A more balanced approach must be found to maximise the benefits to society while mitigating the negative effects on the public health system.

Provocative as Ammar's recommendations may be, a special tax, on top of the value-added tax, should be imposed on foreign visitors seeking medical services in the country.

There are also compelling reasons why private hospitals, which have been doing lucrative business providing medical services to foreign visitors, should also support this idea aimed to rebalance private profits and public benefits.

The arrival of a large number of healthcare visitors, with higher purchasing power, has crowded out many middleclass Thais who now have to turn to public hospitals for medical services because they can no longer afford private healthcare. That puts an additional burden on the already overworked doctors and nurses in the public hospitals, who are already struggling under the under-funded universal healthcare scheme that serves some 40 million Thais.

Proceeds from the proposed special tax can be used to provide better pay for dedicated and hard-working doctors employed by the government to keep them motivated.

To ensure better working conditions for doctors and healthcare workers in the public sector, the government needs to expand the capacity of medical schools to produce more doctors, even if that means slashing subsidies for individual medical students.

Thailand's public health system was designed with a socialistic slant, in which the government, as the country's biggest healthcare provider, exercises considerable control of the healthcare industry, with the noble aim to increase equity of access to medical services by the general public.

The bottom line is, the private sector in general and medical tourism in particular, must not be allowed to grow unchecked at the expense of the public health system.