KHON KAEN, THAILAND – Thailand’s health system reached a critical point as financial losses, staff shortages and capped budgets began to affect services, waiting times and even the number of available hospital beds.
Losses eat into daily hospital operations
Hospitals in many regions struggled with financial losses and tried to cut costs through measures such as limited new hiring and lower staffing ratios. This raised the risk that facilities would have to reduce their bed capacity, further increasing pressure on emergency departments, wards and neighbouring hospitals.
Staff at the limit – and concern over standards
With fewer personnel scheduled, the workload for doctors and nurses increased, which experts believed could directly impact care quality and patient safety. Prof. Dr. Somsak Tiamkao, neurologist and director of Srinagarind Hospital at the Faculty of Medicine of Khon Kaen University, warned that the problems had become so visible that patients could feel them in everyday care.
“The problems have now become so visible that patients can feel them in their everyday lives.”
said Prof. Dr. Somsak Tiamkao, director of Srinagarind Hospital.
Access to treatment grows more complicated
Patients were expected to receive treatment less conveniently than before, as hospitals had to rely more heavily on referrals and allocations to control costs and case numbers. At the same time, Somsak stressed that an efficient, trustworthy referral system was fundamentally correct and should long ago have been developed more consistently to ensure timely and safe care.
“A powerful and trustworthy referral system is fundamentally right and should have been built up more consistently long ago so that care is provided in a timely and safe manner.”
said Prof. Dr. Somsak Tiamkao, director of Srinagarind Hospital.
Treatments confined to reimbursable care
Hospitals increasingly had to follow national guidelines and the National List of Essential Medicines for diagnostics and therapy, because deviations were hardly financially viable. According to Somsak, treatments that could be medically reasonable but fell outside reimbursable benefit packages were being approved less frequently by hospital managements, as such decisions would otherwise deepen the losses.
“Treatments that may make medical sense but lie outside reimbursable benefit packages are being approved less and less, because otherwise the losses continue to rise.”
said Prof. Dr. Somsak Tiamkao, director of Srinagarind Hospital.
Capped budgets send the wrong signal
National policy aimed to prevent service volumes from growing beyond the previous year’s level so that capped funds would be sufficient to reimburse hospitals at the agreed rate. If services measured in RW still increased, the payout per RW fell, which, according to Somsak, pushed hospitals further to limit admissions and keep staffing tight.
“When services measured in RW increase, the payment per RW falls, which further pressures hospitals to restrict admissions and keep staffing low.”
said Prof. Dr. Somsak Tiamkao, director of Srinagarind Hospital.
Fewer beds – and more transfers back home
If hospitals with particularly high losses were to close beds, access to inpatient care would become more difficult and the capacities of surrounding facilities would have to be strengthened in terms of staff, finances and technology. At the same time, Somsak expected more transfers back to local hospitals, which would reduce costs at large centres but would only work if the Health Ministry secured local services with staff and medicines and expanded telemedicine and home delivery of drugs.
“Transferring more patients back to local hospitals can cut costs at major centres, but it will only work if the Health Ministry secures local staffing and medicines and expands telemedicine and home delivery of drugs.”
said Prof. Dr. Somsak Tiamkao, director of Srinagarind Hospital.