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17 April 2013
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Ministry, doctors ‘must fix P4P row’

Dispute over pay scheme is hurting the health system, experts say

Academics have called for the Public Health Ministry and Rural Doctor Society to find solutions for the medical allowance dispute, warning that political games must end as the row is hurting the country’s health system.

Although the ministry’s new system to pay allowances for medical workers via the pay for performance principle (P4P), which took effect on April 1, is expected to improve workload efficiency and services, experts warned it could cause huge problems if the measure is not carefully implemented.

“Both of them should bring this very issue to talk at the table and stop playing nonsense politics or accusations that are simply based on conspiracy theories,” Viroj na Ranong, research director of Thailand Development Research Institute Foundation’s Health Economics and Agriculture Sectoral Economics Program, said.

Viroj has conducted several studies to evaluate the public health system. He said the ministry should allow all medical workers in hospitals or healthcare units to talk together and decide how to allocate the budget, in order to reduce conflicts among medical professionals at state hospitals over distribution of the special allowance.

The old method, implemented since 2008 and preferred by the Rural Doctor Society, aimed to retain medical workers in rural and remote areas where doctors were in short supply. It was based location and the number of years that individuals worked.

The new method is strongly supported by medical workers at provincial hospitals but heavily opposed by staff working at rural hospitals.

Those pro-P4P see the new method as increasing their salary as they have not enjoyed any additional allowance over the past five years. But those anti-P4P said it would reduce their allowance and this amount should be recalculated and paid to them again based on their performance.

The Rural Doctors Society hit back by holding protests outside Government House last month, and demanded that Public Health Minister Pradit Sinthawanarong to be removed. Moreover, 151 doctors including specialists, resigned from rural hospitals to work at private hospitals after learning that the new payment system would cut their additional allowances, they say unfairly.

Viroj believes the new method could improve the efficiency of medical services, should benefit patients and will be fairer in the long run for medical staff who work hard. But he said the ministry should proceed gradually with a scheme that compensates medical staff whose pay will be affected under the new system, especially those in remote areas.

“They [medical staff] have been working with the Public Health Ministry under an implicit contract that they presume will go on. If the ministry wants to change something in the contract, the ministry must convince them that the new contract will be fair for them,” he said.

“The ministry has rapidly enforced this measure. It should give them time – at least four to five years and allow them to gradually to adjust themselves to the new system.”

Rural Doctor Foundation president Dr Wichai Chokewiwat said the P4P principle should be a financial incentive that adds to the old allowance system rather than replacing it, because total replacement would affect medical workers who had done a good job. He said the ministry should have conducted a study to estimate positive and negative impacts before implementing the policy.


First published in The Nation, 9 April 2013.