Manpower Mix in private Hospitals in Thailand: A Census report.

This paper provides detailed information on manpower in private hospitals in Thailand. Results were drawn from the 1990-1992 private hospital census. Results showed that hospitals registered in the Stock Exchange of Thailand had the highest numbers of full time physicians and professional nurses compared with other types of hospitals, such as non-profit foundations, companies and polyclinics. We found variation in staffing patterns in terms of full and part time categories between hospitals in Bangkok and upcountry. Hospitals in the Stock Exchange Market had the highest productivities. During 1990-1992, the percent increase per annum of throughput showed high demand for private hospital services. In Bangkok, outpatient visits increased by 19% per annum ; hospitalisation by 13% ; hospital days by 7%. Increase in demand for intensive care was extra-ordinarily high during this period ; it rose by 31% during 1990-1992, requiring further indepth exploration to explain in the phenomena. The study provided the first comprehensive information on the number of different part time and full time hospital manpower categories in the private sector in 1992 and the percent increase per annum during 1990-1992. It can be used to forecast demand for manpower in private hospitals both in Bangkok and different regions as well as the possible impact on public hospital staffing. Introduction During the early 1990s, there was a significant shifting of qualified trained doctors from the public to private sector, as a result of the private hospital industry boom which stimulated great demand for specialists, nurses, pharmacists and others. Doctors in private hospitals earned a great deal from professional fees for services rendered to patients, in the higher socio-economic band, such as outpatient consultations, inpatient visits and surgical fees. Hospitals deduct part of the physicians’ fees (10-20%) to be remitted to the hospital. In contrast, doctors in public hospitals are salary paid. The salary scale depends totally on years of employment, and never reflects real workload assigned. Overtime for extra-work was paid per session of service, up until recently when the Ministry of Public Health (MOPH) introduced a workload incentive payment. But that scheme is still insignificant. Public doctors are allowed to conduct private practice outside office hours to earn extra-income either through (solo or multiple) private clinics or part time work in private hospitals. A significant gap of total income (from primary and secondary professional services) earned in the two sectors is one of the major causes of brain drain of qualified specialists from public to private hospitals. Table 1 demonstrates average income differential in the two sectors. The issue of the emerging role of private health care in Thailand was well described in Nittayaramphong et al. Table 1 Average monthly income differentials of public and private physician (in Baht) Source University hospital MOPH hospital Private hospital Private clinic Average Main job 14,002 11,652 43,302 81,020 15,534 Second job 20,426 23,467 23,574 15,205 22,585 Total 27,392 29,377 51,853 84,749 31,517 Source: Chunharas et al (1990).