Private Practice Among Public Medical Doctor: The Thailand Experience

Abstract

OBJECTIVES: To explore patterns, behavior, motivation, and the impact of private practice among public medical doctors on the Thai health care system and search for appropriate policies to regulate or mitigate consequences of private practice toward public health services, especially for the poor. METHODS: Both quantitative and qualitative approaches including a comprehensive literature review, an anonymous self-administered questionnaire survey for 1,808 public medical doctors in five selected provinces, and in-depth interviews on key informants in 2002. RESULTS: Approximately 69% of public doctors had undertaken private practice. The main reason for having private practice was income from public services is not adequate. A logistic regression analysis indicated that factors influencing private practice engagement were being male medical doctors and being a medical specialist (e.g. surgeons, obstetricians). The ratio of total monthly income between fully public and dual job-holding doctors was 2.2. In-depth interviews illustrated that implications of private practice were ranging from public-time corruption, neglecting public patients, poor performance in the public sector due to exhaustion from private work, and differences in the quality of care provided towards public and private patients. Existing regulations towards private practice in Thailand tend to be weak with poor enforcement. Responsible organizations such as Ministry of Public Health and Thai Medical Council have neither any policies in this area nor intention to regulate such practice. CONCLUSIONS: Even though private practice provides two useful functions: compensating for the low salary scale of public medical services and increasing access to health care for those who are affordable, its negative impact requires regulations and measures to minimize those consequences. Strengthening of regulatory measures and administrative capabilities with an introduction of new payment methods reflecting performance and quality of care are needed. Indirect measures including changing payment methods for public health care providers, quality assurance (QA), and hospital accreditation (HA) are widely accepted by Thai health care providers.