The future of primary care in Thailand in the context of a global financial crisis

Abstract

Background: Primary care physicians are in short supply worldwide, and Thailand is no exception. The current economic crisis contributes further to this situation. Thailand does not yet have a formally defined and certifying family practice board. In addition, there are two opposing trends in Thailand which stress an adequate supply of providers: 1) Inadequate formal training for primary care doctors; and 2) The ‘brain drain’ caused by the higher salaries in the private sector and the effort to make Thailand a key hub for ‘Medical Tourism’. From one perspective of primary care, Thailand is a developing or transitional country rooted in hospital/specialist care, yet seeking ways to improve overall quality and cost-effectiveness for its people. Objectives: To ascertain the current and future potential for increasing the number of primary care providers in Thailand, and to encourage further research on this question in the context of economic reality and the cultural background of medical care in Thailand. Methods: Literature search of Thai and other international medical journals for ‘Primary care Thailand’; Google Scholar search for ‘Primary care Thailand’; Pubmed search using MeSH terms ‘Primary care’ AND ‘Thailand’. In addition, physicians and administrative staff in Bangkok from private general-travel medicine practice, an academic medical center, two non-profit facilities, and four investor-owned institutions were interviewed. The literature review was completed 13 March 2009, and the interviews were conducted in person during the author’s visit to Bangkok in January 2009. Results: Although there is some interest in promoting primary care more effectively, the majority of medical practice is still hospital-specialist oriented, at least in Bangkok. One exception was in one of the smaller private hospitals, where several well-trained primary care physicians practiced. In addition, some of the larger hospitals noted for medical tourism are developing sections for local Thai patients, and this may encourage recruitment of fully trained family doctors or specialists in general internal medicine. Conclusions: The future of primary care in Thailand remains in question. It needs the change by the political establishment and medical leadership to define formally primary care or a recognized and certified medical specialty. Furthermore, careful research of both national and regional health needs and practices is a critical factor for success.