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Eliminating the Persistent Entity in Healthcare

Remote community hospital in Ratchaburi province, Tanao Sri Hospital, exposed for using a frog-hunting torch as a dental lamp, sparking concern over the state of Thailand's public healthcare system.

,   and  Administrator
5 min read

Eliminating the Persistent Entity in Healthcare

Flashing headlines exposed the troubled state of Thailand's public healthcare system, a grim revelation after viral images showcased a remote hospital using a frog-hunting torch instead of a proper dental lamp.

The heart of the problem lies with Tanao Sri Hospital, a facility near the Thai-Myanmar border, which struggled for years due to unanswered requests for new equipment. Budget approval came only when public outrage sparked through social media. But there are many other state-run hospitals in crisis, experts say.

A Punishing Reality

Financial woes are indeed a significant part of the issue. The revenue from healthcare service charges in the public hospital system has taken a nose dive, plunging from 60 billion baht to 40.6 billion baht this fiscal year—a staggering 9.5% drop. At least four major hospitals nationwide are hanging by a thread, bracing for urgent financial aid to keep their doors open.

But troubles extend far beyond finances. Working conditions in state hospitals are zombie-like, according to Chutinart Chinudomporn, coordinator of the Thai Frontline Physician Union. The northeastern province of Bueng Kan saw 18 intern doctors submit their resignations from Bueng Kan Hospital. Overwhelming workloads, poor work-life balance, organizational injustice, and uncompetitive salaries paint a grim picture of the current state of public health care in Thailand.

Many doctors toil away for almost 100 hours a week—more than double the 45-hour limit mandated by labor law. The surge in work volume can be attributed to the 30-baht universal healthcare scheme, which brings in an enormous patient pool.

"Without urgent structural reform," Dr. Chutinart warns, "more doctors and healthcare workers will resign, and ultimately, patients will be the ones to suffer".

Since 2013, 455 doctors have steadily left the public sector annually, leaving the workforce with an average of about 24,000 doctors supporting the population—a ratio double the World Health Organization's recommended ration.

The Ministry of Public Health is attempting to beef up the number of doctors to fill the gap, but Dr. Chutinart argues that this approach misses the mark, as it fails to address the core of the problem. She insists a broad reform of the system is much needed to usher in greater fairness and justice for medical professionals. "Without a supportive work environment," she emphasizes, "no one will choose to stay".

A Crying Call for Change

Nurses face similar predicaments, says Suwimol Namkanisorn, co-founder of Nurses Connect, an association of nursing professionals. More than 7,000 nurses call it quits on state hospitals each year, migrating to private facilities or even switching careers.

Many nurses and other support staff at state hospitals get pitiful wages, often earning far below the minimum wage. This is because they fall under civil service laws instead of standard labor laws, as state hospitals are run as a government agency. Ms. Suwimol champions an all-inclusive approach to healthcare reform, highlighting that resolving nursing staff's struggles alongside doctors is essential to repairing the system.

Lastly, bureaucratic paralysis is another concern. Ms. Suwimol recommends granting the Ministry of Public Health greater independence from the Office of the Civil Service Commission to enhance flexibility andeffectiveness in management.

Various reform initiatives are being considered, such as flexible employment models, outsourcing, and performance-based salary structures. Raising the penalty fine for intern doctors who breach their contracts and the "autonomous hospital" model—where hospitals manage their own finances and operations independently while receiving government support—are other suggestions on the table.

Banphaeo General Hospital in Samut Sakhon exemplifies a successful implementation of the autonomous hospital model, having greatly improved its financial stability and staff conditions since gaining independent management.

At this present moment, addressing the challengesfaced by Thailand's public healthcare system will require a holistic approach, tackling deep-rooted issues related to staffing conditions, financial resources, and the management structure itself.

  1. The revelation of Thailand's public healthcare system's troubles was highlighted in headlines, with a remote hospital using a frog-hunting torch instead of a dental lamp.
  2. The crux of the problem lies at Tanao Sri Hospital, a facility near the Thai-Myanmar border, facing years of struggles due to unaddressed equipment requests.
  3. Budget approval came only after public outcry on social media.
  4. Experts say many other state-run hospitals across the nation are in a state of crisis.
  5. Financial constraints are a significant factor, with a 9.5% drop in revenue from healthcare service charges this fiscal year.
  6. At least four major hospitals nationwide are facing urgently needed financial aid to stay operational.
  7. Work conditions in state hospitals are dismal, resembling a zombie-like environment.
  8. The northeastern province of Bueng Kan saw 18 intern doctors resign from Bueng Kan Hospital due to overwhelming workloads, poor work-life balance, organizational injustice, and low salaries.
  9. Doctors often work more than double the mandated 45-hour limit, with a surge in work volume due to the 30-baht universal healthcare scheme.
  10. Without urgent structural reform, more doctors and healthcare workers will resign, causing patient suffering.
  11. Since 2013, 455 doctors have consistently left the public sector annually, leaving an average of about 24,000 doctors to support the population.
  12. The Ministry of Public Health aims to boost the number of doctors, but Dr. Chutinart argues that this approach does not address the core problem.
  13. A broad reform of the system is necessary to bring fairness and justice for medical professionals.
  14. Nurses face similar predicaments, with more than 7,000 nurses leaving state hospitals each year.
  15. Nurses and support staff often earn far below the minimum wage, as they fall under civil service laws.
  16. Ms. Suwimol advocates an all-inclusive approach to healthcare reform, emphasizing the resolution of nursing staff's struggles alongside doctors.
  17. Bureaucratic paralysis is another concern, with recommendations for granting the Ministry of Public Health greater independence from the Office of the Civil Service Commission.
  18. Flexible employment models, outsourcing, and performance-based salary structures are being considered for reform initiatives.
  19. The "autonomous hospital" model, where hospitals manage their own finances and operations, has shown success at Banphaeo General Hospital in Samut Sakhon.
  20. A comprehensive approach is required to address the challenges faced by Thailand's public healthcare system, including staffing conditions, financial resources, and management structure.
  21. The public healthcare system's woes should discourage individuals from pursuing careers in these facilities.
  22. However, chronic diseases such as cancer, chronic kidney disease, and respiratory and digestive conditions require consistent, quality medical care.
  23. The science behind healthcare and workplace wellness can help to alleviate these conditions.
  24. In the face of these challenges, the importance of addressing autoimmune disorders, mental health, and cardiovascular health becomes more evident.
  25. The industry must invest in policies that address these issues, ensuring that finance is allocated appropriately.
  26. Science and technology can help improve medical diagnostics and treatment methods, ensuring better outcomes for patients.
  27. Chronic skin conditions like eczema and psoriasis are common, but treatments are often unavailable or unaffordable for many.
  28. Cooking and lifestyle choices play a significant role in overall health and wellness, with emphasis on proper nutrition, exercise, and stress management.
  29. Fashion and beauty trends must consider the impact on health, such as promoting skin-friendly fabrics and cosmetics.
  30. Food and drink choices have profound effects on our bodies, with emphasis on choosing healthier options and understanding food labeling.
A picture of a dental unit at Tanao Sri Hospital, a rural healthcare facility in Ratchaburi province, employing a torch meant for frog hunting instead of a standard dental lamp sparked widespread controversy, exposing the gruesome truth: Thailand's public health system is on the brink.

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