STATE HEALTH SYSTEM
APIRADEE TREERUTKUARKUL
The Public Health Ministry plans to sharply increase the fine medical graduates are required to pay if they fail to complete their three-year internship in state hospitals.
The new fine is expected to be as high as four to 10 million baht, from the current 400,000 baht.
Health permanent secretary Prat Boonyawongwirote said the fine needed to be raised to that level to discourage young doctors from leaving the national health system too soon.
A figure would be proposed for approval at the national medical schools conference next month. Other measures were also being drawn up to prevent medical staff shortages in rural hospitals, including better financial incentives and promotion opportunities, he said.
Currently, medical graduates are only required to work for state hospitals for three years. If they do not want to, they can leave the system for a job in the private sector by just paying a 400,000-baht fine. The six-year state subsidy for each medical student amounts to 1.8 million baht, excluding the cost of facilities and education materials.
About 1,500 new doctors and dentists are supposed to be registering with the ministry each year. However, the number of young doctors willing to pay the fine has continuously risen, since the sum is seen as nominal compared to what they could earn in private hospitals, resulting in a medical "brain drain".
"If the trend continues, the biggest losers will be the government and the poor. All these years the state has been subsidising medical education so there will be more medical professionals serving the public. But as it has turned out, those who benefit the most are the doctors themselves and the well-to-do," Dr Prat said.
A study by the Human Resources for Health Research and Development Office has shown that the regional medical hub project, initiated by the Thaksin Shinawatra government in 2003 to generate national income by drawing foreign patients to private hospitals in Thailand, has worsened the situation. The study says that by 2015 up to eight million people will annually use outpatient services here, and up to 400,000 will use inpatient services at private hospitals.
Somsak Lohleka, the Medical Council president, disagreed with the ministry's idea to sharply increase the fine.
"It sounds more like a punishment than anything else," he said.
Dr Somsak said such an enforcement would only make the country's top doctors move to private hospitals in other countries. He also disagreed with economist Ammar Siamwalla's proposal the private medical services tax be increased for foreign patients. Private hospitals receive tax exemption benefits from an investment support scheme of the Board of Investment.
"Doctors are drawn to the private sector not only because of the better pay and working environment, but also because of the lighter workload," said Dr Somsak. "Therefore the workload of rural doctors needs to be reduced."
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