Thailand: Debating health reform

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Thailand's government and the country's medical community are debating the proposed new legislation to provide comprehensive coverage to patients against medical malpractice. The state has said that the law would strengthen patients' rights and reduce the time and money spent in litigation, while health professionals claim it would add to medical expenses and the workload of practitioners.

Under the Medical Malpractice Victim Protection Bill, all hospitals and clinics would be required to make financial contributions to a special compensation fund for patients who are victims of medical malpractice. The government says that the bill will provide for a no-faults compensation system that will allow patients to apply for support without having to go to court or have their case be subject to a lengthy investigation.

However, medical professionals are worried that the legislation could pave the way for even more lawsuits, using the granting of compensation under the scheme as proof of malpractice. In particular, opponents of the bill are concerned about section 45 of the draft legislation, which says that doctors could face criminal charges and punishment if convicted of medical malpractice.

With such a threat hanging over their heads, doctors say that health care professionals might be reluctant to take on high-risk cases, and would be forced to work more slowly and cautiously while seeking to avoid mistakes. The new law would result in reduced efficiency, according to Somkid Auapisithwong of the Thai Federation of Doctors, Main Hospitals and General Hospitals.

"We're already very stretched," Somkid said in late July. "Some of our nurses have to work almost 365 days. This would add further stress to our staff. They would have to be extra careful with all sorts of risks – and this will hinder their work."

Though the government is seeking input from a wide spectrum of the community on the new law, its proposal to have a broad-based committee study the draft legislation has stalled over claims by doctors that the original panel named by the Public Health Ministry was weighted heavily in favour of those in support of the bill, while leaving professionals under-represented. However, in a move to ease tensions the Public Health Ministry announced on August 7 that it would withdraw its representatives from the committee, with the ministry instead proposing to provide administrative support, information and assistance.

Concerns still persist, with hospitals and medical practitioners worried about the financial implications of the proposed legislation. Churdchoo Ariyasriwatana, the president of the health care federation and a paediatrician with a state children's hospital, warns that there could be a high financial and personal cost stemming from the new law if it is implemented in its current form.

"A big state hospital would have to foot an additional bill of $313,000 a year contributing to the fund," Churdchoo said in an interview with the Associated Press news agency on August 10. "If the medical workers find themselves stretched and make mistakes, who would protect them?"

According to Tapanavong Tanguraiwan, an ophthalmologist at Phra Nangklao Hospital and a spokesperson for a network of doctors opposing the current form of the bill, the cost of contributions to the fund by hospitals, clinics and pharmacists could be $0.15 for each outpatient and $2.50 for every inpatient. If the compensation fund were created, it would have an estimated $157m to manage each year, he said, adding that such an important policy issue should be subject to the widest possible discussion and not be rushed.

Doctors in private practice are also concerned that insurance premiums will go up as a result of the new stipulations. However, statistics issued by the National Health Security Office show that most malpractice suits are against public heath institutions, rather than private hospitals or non-state providers. Of the 810 complaints lodged in 2009, 789 were filed against state facilities. Total paid compensation was $2m.

Pongpisut Chongudomsuk, the director of the Health Systems Research Institute, disagrees with critics of the bill, believing that once enacted the new law would reduce the number of malpractice suits and strengthen the health system. "The compensation for patients facing medical errors would be a safety net for the patients and a tool to improve the public health system," Pongpisut said in an interview with the Bangkok Post on July 29.

Both the government and representatives of the medical profession say they would discuss the proposed legislation and amendments, though it appears the consultation will be lengthy. The final shape of the bill will depend on the input of all parties involved.

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