Health Policies unhealthy

Concern over lack of personnel to implement cheap medical services

What's the good of free medical care if there are no health personnel to provide it? This is the question that none of the political parties engaged in a fierce populism bidding war has even tried to answer.

The election campaign has seen the parties focusing their health platforms on extending free medical services to the public. The shortage of medical workers like physicians and nurses is a chronic problem that has been all but ignored by politicians.

The reason is simple. Free or cheap medical services are more attractive and easy to promise. Long-term investment in personnel can't win votes.

"Many medical workers, especially doctors, are frightened every time politicians pledge to extend medical services to people," Dr Wiwat Kohwiriyakamol, provincial public health chief for Loei, said recently.

Many state-run hospitals in Loei are understaffed. Doctors especially, including heart surgeons, are now resigning due to the heavy workload imposed by the government's extending health services.

They are also lured away by offers of fatter paycheques from private hospitals in big cities like Bangkok. Most heart patients are transferred to nearby provinces such as Udon Thani or Khon Kaen.

"Extending free medical services is good for patients and politicians but it is bad for us as we don't have enough workers," he said.

During the past few years, the provincial public health office has been offering scholarships for doctors to study specialities such as heart disease but there was no place for the recipients to study at the medical school and excellence centre.

"This was caused by the shortage of experts at the excellence centre to teach doctors," he said.

The Medical Council's recent records show that 39,395 physicians are practising around the country but 9,772 more are needed to fill the public health system.Dr Chanvej Satthabhud, president of the Trauma Association of Thailand, said there was a critical need for physicians to perform emergency treatment for accident victims.

"We have only 300 (emergency) surgeons and neurological surgeons working at hospitals across country, [and only] 50 of these are now working at rural hospitals nationwide," he said.

The nursing shortage is another issue that has been unmentioned in election campaigning.

Many general and provincial hospitals, especially in the Northeast, are now left to fend for themselves, said Nongluck Pakraiya, manager of the Human Resources for Health Research and Development Office.

According to her agency's survey, the country needs 180,435 nurses but now has only 138,710.State hospitals compete among themselves to offer grants of Bt60,000-Bt160,000 and other benefits to freshmen nursing students for signing a contract they will work for the hospital for four years after graduating.

Dr Peeraphan Suwanchaimart, director of Khon Kaen Hospital, admitted the hospital has provided Bt60,000 nursing scholarships in return for agreeing to serve at the hospital for two years.

But due to the tough schedule, some gradually leave to join private hospitals, he added.

To improve the quality of medical services over the next four years, the Democrat Party has proposed measures including reducing the gap between the three healthcare funds, extending Social Security medical benefits to families of subscribers and drafting a five-year blueprint for the National Health Security Fund's financial management.

The Pheu Thai Party would bring back the Bt30 co-payment after the Surayud Chulanont administration scrapped the co-payment scheme and made universal care free.

Medical services would be made available after office hours but patients would need to pay Bt300. A senior academic of the Thailand Development Research Institute urged the new government to send more doctors to rural areas.

Dr Amphon Jindawattana, secretary-general of the National Health Commission, said the parties' public health policies do not go beyond putting a lot of money into medical treatment instead of pushing healthcare promotion and prevention and producing medical personnel.

"If all political parties do not change their direction from medical treatment to healthcare prevention, the country could face bankruptcy in the near future," a senior health official said.

Dr Itthaporn Kanachareon, deputy secretary-general of the Medical Council, said the new government and the Public Health Ministry must consider how to maintain sufficient professional staffing in the public health system.

"Stopping the government's policy to limit the growth of civil servants especially medical workers would be a good way to resolve this problem," he said.


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