Eliminating the Undead Healthcare Entity
In the realm of Thailand's public healthcare system, the stark reality is out for all to see: it's struggling. A now-viral photo of a makeshift dental unit at Tanao Sri Hospital, a remote hospital in Ratchaburi province, employing a frog-hunting head torch due to a lack of proper equipment, set tongues wagging across the country.
The hospital, situated near the Thai-Myanmar border, had been fighting a three-year battle to secure new equipment, only receiving approval for funding after the image sparked widespread outrage on social media. But Tanao Sri isn't the only public institution battling financial hardships – keep reading to uncover the broader narrative.
Gut-wrenching stories of struggle
Sadly, Tanao Sri's fortunes appear to be an exception rather than the norm. According to Chutinart Chinudomporn, coordinator of the Thai Frontline Physician Union, the Ministry of Public Health is grappling with a painful 9.5% drop in revenue from healthcare service charges across the public hospital system this fiscal year – a fall from 60 billion baht to 40.6 billion baht.
Hospitals nationwide are in dire straits, with at least four major institutions teetering on the edge of financial collapse, requiring urgent financial aid to stay operational.
Beyond finances: resignations and unbearable working conditions
The problems go far beyond budgetary troubles, says Chutinart. In the northeastern province of Bueng Kan, 18 intern doctors recently quit Bueng Kan Hospital, citing poor working conditions. These include overwhelming workloads, poor work-life balance, organizational injustice, and uncompetitive salaries.
Many doctors work up to 100 hours per week, twice the 45-hour limit stipulated under labor law – mainly due to high patient volumes under Thailand's 30-baht universal healthcare scheme. "Without urgent structural reform," warns Dr. Chutinart, "more doctors and healthcare workers will resign, and ultimately, patients will be the ones to suffer."
A brain drain: medical professionals leaving in droves
Between 2013 and 2022, an average of 455 doctors left the public sector each year. With about 24,000 doctors under the ministry, this means that 1 doctor in the public health system serves approximately 2,000 people – double the World Health Organization's recommended ratio.
The ministry is attempting to increase the number of doctors, though many argue this approach misses the mark. Instead, massive systemic reform is needed to create a fairer, more supportive work environment, as highlighted by number crunchers like Jarauyporn Srisasalux from the Health Systems Research Institute. "Without this," she adds, "no one will choose to stay."
The forgotten heroes: nurses and support staff
Similar challenges confront nursing professionals, with most nurses leaving state hospitals to either move to private hospitals or switch careers altogether. According to Suwimol Namkanisorn, co-founder of Nurses Connect, over 7,000 nurses abandon state hospitals annually – often to find better pay elsewhere.
State hospital workers, who are subject to civil service laws rather than standard labor laws, often find themselves earning unlivable wages, particularly support staff like stretcher crews, who earn significantly less than the minimum wage stipulated by law.
True healthcare reform, contends Ms. Suwimol, requires collaboration across all sectors – not just solutions for doctors. "Leaving nurses and other staff behind," she notes, "will not fix the system."
Paralyzing bureaucracy: red tape putting patients at risk
Finally, Suwimol also touches upon the lack of budget flexibility at state hospitals, advocating for autonomous hospital models. She suggests allowing the Ministry of Public Health to operate independently from the Office of the Civil Service Commission, arguing that such flexibility would improve management and, in turn, lead to better patient care.
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 dissatisfied with their conditions. The grim facts: poor working environments (61.4%), heavy workloads (51.7%), and low pay (42.9%) were the top complaints. It’s high time that something is done to address these problems.
- Hospitals across Thailand, including Tanao Sri Hospital, are encountering significant financial hardships due to a 9.5% drop in revenue, highlighting the struggles within the public healthcare system.
- Beyond financial troubles, various medical institutions, such as Bueng Kan Hospital in the northeastern province, face issues like poor working conditions, overwhelming workloads, and uncompetitive salaries that contribute to resignations of healthcare workers.
- The lack of support for nurses and other hospital staff, like the low wages earned by stretcher crews, and the red tape within the system are concerns that need to be addressed to achieve comprehensive healthcare reform.
- The combination of inadequate funding, unfavorable working conditions, and bureaucratic issues discourages medical professionals from remaining in the public healthcare sector, potentially discouraging others from entering it, and consequently, impacting the quality of health and wellness care available to the public.
