Thailand struggles to strike a balance between high cost, quality healthcare

Thailand may be a healthcare paradise, but what could be the biggest crack in the country’s laudable healthcare system?

Thailand may easily be deemed as the healthcare winner in the ASEAN region if doctor salaries, patient coverage, and medical tourism lead are anything to go by.

This was fleshed out by attendees at the Healthcare Asia Leaders Roundtable 2017 held last March 14 at the Conrad Bangkok.

In the Philippines, one of the biggest healthcare problems is that doctors leave after they train. Doctors in the Philippines are paid roughly THB40,000 (US$1,186) and they leave because of unenticing job offers. What are some of the problems in the Thai industry in terms of costs, staffing, and funding of hospitals?

Dr Surangkana Techapaitoon, hospital director at Samitivej Children Hospital, said that with regard to striking a balance between soaring costs and high quality healthcare, Thailand’s main challenge is keeping up with the new healthcare technologies.

“Patients are constantly hoping that the care they receive from hospitals are high-tech in nature, they want to experience using new hospital innovation, but they also do not want to pay extra charges entailed by this innovative service,” she added.“This is where the problem starts, both private and public hospitals cannot shell out the money needed to upgrade their treatment technology without patients that are willing to spend the equivalent baht. We would like to spend more because this is also to help our patients, especially in our case as we are a children’s hospital.” Dr Techapaitoon added that the industry must address issues on how to balance the cost, the patients’ needs, and business strategies to benefit all parties involved. “We should zero in on how to utilise current and upcoming technologies without passing on too much costs to patients, how to effectively implement this, what strategies must be in place to lessen the costs but maintain the high quality of treatment.” 

She added that for a doctor fresh out of medical school, the average salary would be around THB30,000 (US$889) per month for general practitioners in government hospitals. For specialists, it would be around THB40,000 (US$1,186)-50,000 (US$1,482) per month. But if general practitioners work in a private hospital, it would be around THB100,000 (US$2,965) and for specialists, estimate would be around THB200,000 (US$5,931). This, she said, may be a strong reason why unlike the Philippines, Thai doctors choose to stay where they are and don’t opt to leave. In some of the other countries, particularly in Malaysia, there is a surge in demand for IT to support the infrastructure of the hospital with regards to technology. The question is where do we get the budget for these innovations? This is a big trade-off that a number of hospitals in the region are trying to make, and chief financial officers are saying that there is no clear return on investment on many of the hospital equipment that they are going to buy. Is the Thailand healthcare industry experiencing a similar dilemma? Gavin Wadell, international head marketing executive of the business development department of Phyathai International Hospital, explained that from the private hospitals’ point of view, “We spend a lot of money in buying the latest technology to provide what we can for the patients. I’m not qualified to comment on behalf of the sector, but talking about the equipment that hospitals buy, I think investing on these kinds of technology still puts the hospital in a good position despite shelling out cash.”

High quality, high spend

Joni Java, international marketing executive at Vejthani Hospital, agreed and added that for a high quality of healthcare to be given, high technology is necessary. “But for the economic aspect, we cannot really decrease our prices so much. As a private hospital, we should be price competitive--prices should not be high, but not too low,” she said. Dr Techapaitoon also commented that private-public partnership may be a key in improving the quality of healthcare and maintaining the affordable costs at the same time.

As for the government’s healthcare funding system in Thailand, there is a new policy that private hospitals must take care of emergency cases. “Before, it was optional. But after the policy was passed in the parliament, there is now this rule that private hospitals should take care of emergency cases before the patient can transfer to public facilities. My concern on this is that the government should take part in this ‘investment’ on patients, there should be more trainings for public hospital players, and more partnerships so we can increase both the private and public sectors’ abilities to take care of the patients,” Dr Techapattoon added. Is it too soon to say that private hospitals will be inundated with emergency patients that the government is paying for? Is this actually economic for the hospitals or is this something that will be cost-straining? Wadell answered that private hospitals openly accept social security patients, or those whose payments will be from their social security accounts. “We are assisted by the government, and we are grateful for that,” he said.

Kessara Jaitang, international marketing head nurse at Phyathai International Hospital, added that in her hospital, there is a separate admission room for the private patient and the public patient. “This is so that patients who want and can pay for better services can actually obtain what they have worked so hard for. Social security in Thailand works very well, and covers those who have utilised this.” Wadell added as an example, “My friend who used to work as a co-teacher in a university was covered by his social security. Unfortunately, he passed away in our hospital—he’s been there for three or four months. His hospital bill was then THB1.5m (US$44,484), and the social security covered 99% of that. I think the social security is doing a really good job for the people in Thailand.” Dr Techapaitoon explained that in Thailand, there are three kinds of healthcare coverage: social security, universal coverage, and civil coverage for government workers. Everyone can obtain any of these coverages, but there are certain hospitals that the government does not allow to recognise these privileges. “In the future, I think that we will not be able to charge as much as we would like. This is why I have been emphasising from the start that both private and public players must follow the appropriate processes so everyone gets fair coverage and treatment.”

Some areas in the region, particularly Philippine provinces, are crying out for doctors and nurses to come back, work there, live there, and serve the government hospitals. Regional hospitals are now trying to convince them to stay in the provinces. Is Thailand experiencing the same issue? Java, coming from the Philippines, explained that the cost of living in Thailand as compared to the former is a lot lower which makes all the difference between Thai doctors who choose to stay and Filipino ones who choose to go. Where is Thailand headed now in medical tourism—is it still number one or is it under threat? Wadell described the current status as “rising” as more health travelers can easily come here. “I still feel that Thailand is number one in the area. As soon as I mention Singapore to foreign patients, it’s the same response all the time: ‘It’s so expensive!’ When they come here in Thailand for medical treatment, they can also experience the tourist spots.” However, Java added that Middle East patients have decreased, which could be due to the oil price change, and in Vejthani Hospital, the change was really felt. “Consequently, some of the coverages were also decreased. So instead of 100% coverage, it has been dowsized to just 60% or 40%.”