Abstract
Geographical imbalance of physician is a globally chronic problem of health service, particularly in countries which has overall physician’s shortage. The geographical imbalance negatively affects the efficiency and equity of health system in both areas, high and low health workforce’s density. In Thailand, physician’s distribution problem plays a major role in indicating the success or failure of health insurance schemes.In 2005, Thailand has approximately 25,600 physicians who have active service status. With this figure, the overall physician shortage is around 4,500, compared with the demand forecast, which was conducted before universal coverage health insurance implementation. However, there are at least 3 main factors, currently triggering the rising of demand for physician in our country, including 1) universal coverage health insurance scheme, 2) Thailand as an Asian Medical Hub policy and 3) universal coverage for anti-retroviral treatment for HIV infected population. The additive burdens from these 3 policies are equivalent to 1,222 full time physicians’ performance. The physician’s distribution discrepancy does not substantially change from the trend in last few decades, although Thailand has 3 significant increases in physician production in the same period. Furthermore, the mushrooming of private sector, as a result of economic recovery, severely aggravates the discrepancy, in term of internal brain drain.Incentive system is the popular tool to alleviate the discrepancy. It affects physicians, by both attraction and maintenance physician in the shortage areas. Unfortunately, the existing incentive pattern does not strike a balance among many types of incentive. Non-financial benefit is always less prioritized. In addition, increasing of public physicians’ incomes alone is prone to have an adverse impact, in term of spurring the national health expenditure.In the macro view, Thai physicians receive less income while suffer from more workload burden, when compared with other countries in the same region. Internally, there is significant difference of total incomes between public and private physicians. A sampling phone survey shows 37,000 and 50,000 Baht in monthly incomes in resigned general practitioner and specialist physician, respectively.Implemented measures to mitigate the geographical imbalance display the irrelevance of strategies and roles of stakeholders. Therefore, it’s necessary to improve the existing policy and strategies to effectively solve with this problem, with sustainability. The policy recommendations, drawn from this study, are including 4 parts of policy, as followed;Supply policy: the physician supply can be improved by 1) increasing in number of physician, which are including new production and activation of service inactive group and 2) improvement of productivity by arranging the optimum skill mix and specialty mix, including establishing of flexible employment i.e. public-private mix.Distribution and utilization measures: Revisions of existing procedures are urgently need including educational contracting, physician allocation method, long term development system and migration. Incentive measures: the physician’s incentive system should reflect the shortage situation and performance, as well as focusing on effective non-incomes incentives.Other measures: these are including 1) preparation of physician to shortage context, 2) applying of health workforce demand identification concept to both public and private investment and 3) utilization of physician as public asset, such as financial mechanism to support the optimum physician’s distribution.
