Free treatment, but where is the medical staff?

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EDITORIAL

Free treatment, but where is the medical staff?
The Nation 2011-06-18

Populist health schemes sound good but cannot work unless the government helps to provide enough doctors and nurses to run them

During this election campaign, politicians have promised voters free or virtually free medical services. However, they are missing the point, as the real issue facing Thai public health is not the cost of service but whether we have sufficient personnel to care for those in need.

The Democrat Party has promised voters it will increase the universal healthcare budget to Bt130 billion per year, while the Pheu Thai Party says it will continue the Bt30 universal healthcare scheme initiated by its predecessor Thai Rak Thai Party.

Some politicians may argue that the public wants the populist approach offered by all the political parties. But the parties still do not understand that all governments have failed to address the root causes of the public health problems.

Regardless of how excellent a healthcare programme is on paper, the public will not be able to benefit from it if there are insufficient health personnel.

Any government can claim that it will provide free medical treatment. But this will be useless if hospitals, especially those in the provinces, are desperately short of physicians and nurses.

The understaffing situation at some public hospitals has become worse partly because of the government's extended healthcare programme, which puts more pressure on public hospitals, which are already short on government-provided resources.

Many physicians have left the public hospitals in remote provinces to work in private hospitals in Bangkok and other big cities where they have less work load, better support facilities and more equipment to perform their duties.

The shortage of staff is seen in recent statistics from Medical Council records. It shows that 39,395 doctors are practising around the country, but at least 9,772 more are needed to fully serve the public health system. Dr Chanvej Satthabhud, president of the Trauma Association of Thailand, was recently quoted as saying that there was a critical need for extra physicians to perform emergency treatment for accident victims.

He added that the Medical Council's records also show that we have only 300 emergency surgeons and neurological surgeons working at hospitals across the country, and only 50 of these are now working at rural hospitals nationwide.

The situation in the nursing profession is no better. Thailand needs 180,435 nurses to provide adequate coverage, but the Kingdom now has only 130,710. Again, the shortage is more serious in rural provinces.

The ongoing social division is a result of inequity in our society. Many people feel they have been unfairly treated in a variety of ways. They feel they have been denied access to public services and education opportunities. People in the countryside certainly don't have fair access to quality schools, hospitals and clinics.

These are the issues that the new government must tackle. But so far the candidates have focused instead on populist economic approaches. Promises of free medical treatment are fine, but the quality of such a service is very much in question.

The other issue that politicians conveniently forget is that better public health can be achieved through prevention. A proper public healthcare policy needs to work from both sides: prevention and treatment.

The most effective way to promote good public health is to ensure that the public is educated and encouraged to be mindful of their health. A substantial effort should be placed on how to teach people to stay healthy by eating vegetables and fruits. Thailand is already beginning to face the serious obesity problem that has afflicted developed nations for decades.