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Published on February 6, 2008

It has taken the Public Health Ministry some time to wake up to the inconvenient truth that former PM Thaksin Shinawatra's ambitious plan to turn Thailand into an international medical hub to serve foreign patients has the potential to undermine the country's once-strong public health system. Government health experts are now questioning the project which was launched in 2003 and also known as the Medical Tourism Promotion. A high-level panel has just been set up by the ministry to assess the impact of the scheme on the country's public health system. According to information released by the ministry, most of the benefits, to the tune of Bt200 billion over the past five years, have gone to private hospitals, while the public health system has shouldered much of the cost in terms of worrying "brain drain" and deteriorating working conditions for government-employed doctors and nurses. It is interesting to note that the negative impacts caused by the scheme to the public health system have been clear for everyone to see, but the ministry has done virtually nothing to mitigate these effects.

While in power, Thaksin and his cronies invested heavily in the private hospital business to take full advantage of his policy to promote the private healthcare industry at the expense of the public system. Worse, the public health system has been weighed down by the burden of the universal healthcare scheme, which struggled with on unsound and unsustainable financing.

The Public Health Ministry has now mustered the courage to raise the issue with a view to finding a solution. But it lacks in-depth analyses to be used as basis for discussion. The current move is very important for the public health system - better late than never. When the health panel chaired by Privy Councillor Kasem Wattanachai convenes its first meeting next week, it must review the international medical hub scheme, which appears to be based on the assumption Thailand has an excess capacity to provide healthcare that can be exploited without having a negative impact on services used by tens of millions of grass-roots Thais.

An answer must be found on whether such an assumption is true or false before any attempt is made to find a solution on how to deal with the issue. A way needs to be found to maximise the benefits to society while mitigating the negative effects on the public health system.

Based on available statistics, the country's public health system is still a long way from meeting its target of providing one doctor per 1,800 people, a key indicator of the quality of healthcare services provided by the government. In other words, the system still suffers from a shortage of doctors. More than 30,000 physicians were required in the public health system last year, but thousands of vacancies remain unfilled - the result of an exodus of government-employed doctors to the lucrative private healthcare industry.

This "brain drain" has been a problem for decades, but the scheme to provide foreigners with relatively lower cost, high-quality healthcare in this country could make the situation a lot worse.

Thailand's public health system was modelled on a utilitarian approach in which the government retains the power to intervene in the health industry through regulation and pricing to increase the equity of access to healthcare. The government has always been the biggest healthcare provider and therefore is able to counterbalance the profit-oriented private healthcare industry and control cost escalation in the public sector. This model has served the country well, as it has provided the majority of people with access to adequate medical services. These are people who would not otherwise be able to afford modern healthcare.

Obviously, a more balanced approach is called for. On the one hand it is undeniable that the private healthcare industry, which has earned vast amounts of hard currency catering to foreign patients, has contributed greatly to the economy. But private healthcare providers must, one way or another, pay back society for the use of the country's limited health resources. On the other hand, hard-working doctors employed by the government must somehow be compensated in order to keep them motivated, and their working conditions must be improved. These are essential if the public health system is to continue to provide quality healthcare for all Thai citizens. 

The Nation