Health-sector performance-pay plan stirs debate

national March 27, 2013 00:00

By Chularat Saengpassa
The Natio

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The Public Health Ministry is planning to introduce a "pay for performance" system for the public-healthcare sector in April next year. With it, medical workers in many rural areas will lose some part - if not all - of their special allowance.

Chana Hospital director Dr Supat Hasuwankij, of the Rural Doctor Society, said the special allowance had been provided to help rural areas retain medical workers.

“Pay for performance will not help here,” Supat said.
He said that thanks to a 2008 initiative, doctors, pharmacists, nurses and dentists saw their special allowances soar for additional years of service in remote areas. 
“Through that initiative, the number of medical specialists has risen by at least 200 per cent.” 
He said he wanted to ask the government not to reduce the number of medical workers in rural zones and prevent any shortage if it goes ahead with the pay-for-performance idea. He also pointed out how difficult it would be to evaluate the performance of medical workers.
“Some doctors work fast. They can treat a high number of patients in a day. But some work at a slower pace to examine the condition of patients closely. How will you evaluate them?” Supat asked. 
He said nurses at a small hospital usually knew to which doctors patients should be sent. 
“Our minister [Public Health Minister Pradit Sinthawanarong] does not seem to have the qualifications to stay in his post,” Supat said. 
He added that hospitals were not canning factories where Pradit could assess the performance based on the number of cans. 
Dr Prachum-porn Booncharoen, president of the Thai Federation of General and Central Hospital Doctors, said pay for performance would not really remove the incentives for doctors working in remote areas.
“They will still be entitled to a special allow-ance. In some very remote areas, the amount will not drop. In other areas, the amount will be adjusted to ensure all medical workers get the extra wage,” she said.
Prachumporn said the special allowance would disappear only if the rural medical workers had been in the services for more than 21 years. By that time, she said, they already held executive positions and received another type of allowance associated with those posts. 
“The pay-for-performance system will mean fairer remuneration for young doctors,” she said. 
Prachumporn said at rural hospitals, those who had to work really hard were mostly young doctors.  She said older doctors should not try to block pay for performance because they would lose some benefits. 
She shrugged off suggestions that some rural doctors would resign if the scheme were introduced. 
“Rural doctors resign all the time, many for further study and many for jobs at state hospitals. That happens regardless of the new system.” 
Prachumporn also pointed out that the pay-for-performance system had been tried at some hospitals and the results were good. 
“The delegation of job responsibility has improved. No one has to shoulder the huge workload alone,” she said. She insisted the pay-for-performance system would not hurt the public-healthcare sector.

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