'P4P caused disputes at hospital'
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Mixed response at pilot centres to new health policy
Some urban hospitals may be able to boost efficiency by following the pay-for-performance principle to optimise workloads, but for some rural hospitals this new practice has created problems.
Dr Prasitthichai Mangchit, director of Saraburi’s Kaeng Khoi Hospital, said yesterday: “We have been implementing this concept to pay an extra allowance to medical workers for three years but we found that many of them were competing and fighting each other to keep score for the allowance.”
The rural hospital is one of 10 piloting pay for performance, which was introduced by the Public Health Ministry and approved in principle by the Cabinet on Tuesday in a bid to improve the efficiency of medical workers at the ministry’s hospitals nationwide.
The P4P system, as it is known, bases the allowance on work results, and replaces an earlier policy based on location and the number of years worked.
The old method was aimed at retaining medical workers in rural and remote areas where doctors are in short supply.
But the ministry found some medical workers were receiving the allowance even though they did not do their job very well and spent time on other business.
The ministry’s push for P4P has been strongly opposed by thousands of rural doctors and medical workers over the past few days. They see the new method as a threat to their income and claim it would destroy their motivation to work in outlying areas.
According to the Rural Doctor Society, at least 15 rural doctors and medical workers in Chiang Rai and Phayao have already resigned after they learnt that their allowances will be cut when the ministry starts the new rates on Monday.
“We told the ministry about this problem in the past few years – that this method would be a burden on the hospital, to collect data and calculate the allowances,” Prasitthichai said.
Kaeng Khoi Hospital is now spending about Bt100,000 on allowances for 200 medical workers, including doctors.
The allowances range from Bt200-Bt1,000, but it is very complicated to calculate the payment for each worker as each job description is very different.
While P4P was a good idea, he thought it should be implemented gradually to allow hospitals time to adjust.
Meanwhile, Makarat Hospital in Kanchanaburi is an example of a site where P4P has succeeded.
“Each medical worker has his own assignment and knows what he has to do. They have never competed among themselves for allowances,” deputy director Boontuen Poonsiri said.
The hospital has been using this method since 2008 to motivate medical staff to work at the hospital as long as they could. But it is a general hospital, so it was not eligible for the old system.
However, it spent Bt1 million of its own funds for a special budget to support allowances based on work indicators.
“If you work hard you get more allowance. If you don’t work you get nothing. If everyone works together they will get the same allowance,” she said.
The hospital has set up criteria based on workload to calculate the rate of allowance. Each medical profession has a specific rate. For example, dentists will get Bt7,000 if they meet the conditions but the allowances for other professionals would be more or less depending on the conditions of their job.
“We found that the quality of medical services provided to patients has improved since we implemented this concept,” she said.
