No windfall from rural flight

Private hospitals expect to reap little benefit from rural doctors quitting the public sector over the pay-for-performance system introduced by the Public Health Ministry.

"There's still lots of misunderstanding about concerns that the ministry's proposal will drive an exodus of state medical professionals to the private sector," said Dr Chalerm Harnphanich, chairman of Bangkok Chain Hospital Plc, the SET-listed hospital chain under the Kasemrad brand.

"State medical professionals are mostly general practitioners, but what private hospitals are in dire need of is specialists."

Of the 45,000 doctors in Thailand, one-third or 15,000 are employees of the Public Health Ministry.

Large numbers of medical professionals are resigning from community hospitals due to the slashing of hardship allowances and the pay-for-performance scheme.

Dr Arak Wongworachart, a former president of the Rural Doctors Society, said 146 doctors resigned in February and March.

Most of those who left were recipients of government grants and had yet to complete their years of commitment to rural hospitals, Dr Arak said.

The resignations came within two months of the new policy being announced.

Before the introduction of the hardship allowances in 2008, more than 600 rural doctors were resigning every year from community hospitals. That figure halved with the launch of the incentive scheme.

The original hardship allowance was based on each doctor's degree of isolation and working conditions. But as of Monday, it was replaced with a performance-related pay system.

Under the scheme, 50% of doctors will have their hardship allowance cut by half, with the rest paid according to their performance.

Exceptions apply for those working in high-risk areas such as the deep South, where allowances will remain unchanged.

Dr Chalerm said resignations of state medical staff are normal, with 400-500 state doctors leaving every year.

"State medical staffers who have resigned have mostly shifted to pursue their own businesses such as plastic surgery or beauty centre-related franchises, with a handful joining private hospitals," he said.

Dr Boon Vanasin, owner of the Thonburi Hospital Group, said the pay-for-performance scheme is commendable, but the government is expected to face continued protests and growing resignation threats by state medical professionals.

He said rural doctors are well paid, with salaries and allowances much higher than those of their peers working in Central Plains hospitals and large state hospital chains.

"Most rural doctors practise only basic medical treatment, with tertiary care transferred to central provincial provinces," Dr Boon said.

Doctors at provincial hospitals are paid about 70,000 baht a month, much lower than the 100,000 baht earned by rural doctors, he said.

"Efforts by the ministry to make it fair to doctors who have more workload are in fact commendable," Dr Boon said.

"But whether this will result in a flight of state medical staff is a different issue, as those who work for state hospitals should by nature work with passion and sacrifice."

About the author

Writer: Charoen Kittikanya
Position: Business Reporter