Warning on healthcare system

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Warning on healthcare system
By PONGPHON SARNSAMAK
The Nation 2011-03-1

Urgent action needs to be taken to overcome a financial crisis affecting hospitals across the country, according to the Senate Standing Committee on Public Health.

A study conducted by a subpanel of the committee has found that since the start of the universal healthcare scheme, 48 million people have made 140 million medical visits to hospital outpatient's departments and 5 million medical visits as inpatients.

However, insufficient budget provision by the National Health Social Office (NHSO) has left hospitals across the country in a state of crisis.

"The country's healthcare system will collapse, due to increasing provision of medical services and a decrease in service providers," said an advisor to the standing committee, Dr Ittaporn Kanachareon.

"The government needs to set up an ad hoc panel to resolve the shortage of medical personnel and the insufficiency of medical services," he said.

The committee's study of universal-healthcare coverage and urgent problems related to public-health issues found that the financial crisis at state hospitals was caused by the budget-allocation methods of the National Health Security Office. The NHSO makes budgetary provision for state hospitals and healthcare providers across the country.


The NHSO's budget provisions include the monthly salaries of healthcare workers plus 60 per cent of the per-head budget for providing medical services to patients.

Hospitals with large numbers of medical workers have been facing a financial crisis for several years. They have been forced to take from the 60-per-cent-per-head budget to pay the monthly salaries of medical workers and have been left with insufficient money to run the hospitals and provide medical services.

Moreover, hospitals in parts of the country with small populations have faced a liquidity problem because their budget allocations have been reduced according to their smaller population base.

"Efficient budgetary allocation to hospitals across country is a duty of the National Health Security Office, to help them to survive. But now, they are unable to survive," Ittaporn said.

The study also found that while the per-head budget for providing universal healthcare coverage has increased substantially over the past eight years, the monthly salaries for medical workers at state hospital have increased only slightly.
A prominent economist and member of the National Health Security Board, Ammar Siamwala, said the financial crisis at state hospitals was caused by the use of hospital budgets to pay increased special allowances to medical workers. Most hospitals whose budgets had run out were now blaming the NHSO for the financial crisis.

He said that increasing the monthly salaries of medical workers at state hospitals was essential if the government was to take care of the situation.

In a bid to improve the financial plight of state hospitals, the Senate standing committee has urged the National Health Security Office to make budgetary allocations to help hospitals with debt crises and has also asked the government to increase payments to hospitals.

It said the government should separate monthly salaries for state-hospital medical workers from the per-head budget provided by the NHSO to run the hospitals. In this way, the government would discover the real cost of running the hospitals and providing medical services.

To resolve the long-standing problem, the government should also set up a national unit to oversee the finances of the country's healthcare-insurance system.

The NHSO has spent more than Bt160 billion on healthcare services provided to 48 million people over the past 10 years. It recently asked the government to increase the per-head subsidy for the universal healthcare scheme from this year's Bt2,546 to Bt3,249 in the 2012 fiscal year.

Monthly salaries for medical workers at state hospitals are only 27 per cent of the size of the per-head budget.