I can't believe it is my last week here. Was it
really almost 6 weeks ago that I sat on a plane next to a professor of art
history and scholar of Burmese religious objects, while on my way to
Burma/Myanmar before coming to Thailand?
Besides being able to pick his brain about the historical sites and
religious relics I should see in Burma/Myanmar, he introduced me to a different
medical concept: that the government health care system could be the best
health care system, even with a good private system.
This professor spends part of his life living in
Thailand and part in the United States. He chooses to get his health care in
Thailand due to the cheaper price tag. But it is more than that. He also
chooses Thai government hospitals over private hospitals, because he says they
are better.
I know Thailand is known for medical tourism, such
as high quality sex change operations, joint replacements, cosmetic surgery,
etc. Any elective procedure you can think of, you can find a boutique hospital
in Thailand that caters to tourists looking for a cheaper option, generally in
a hotel/resort type atmosphere, fully including relax time on a beach.
But a government hospital? Where the money does not
go to fancy beds, decorations or iced latte's?
The concerns in the United States about a
socialized, single-payer health care is that it will decrease the quality,
increase wait times, and provide poorer healthcare than our current
system. Although, working in the current
system I still see the people who don't ever get care, the minorities who get
worse care, and that US health outcomes are poorer than most of the high-income
world. But, put that all aside for a
moment.
Recently the Veterans' Affairs' scandal about faked
numbers and long wait times encouraged the belief that a federal medical system
in the United States would increase wait times.
My own previous experience in Uganda was that
government hospitals were considered worse than private hospitals. In Brazil, a
nice upcoming BRIC country, where the government hospitals don't lack supplies,
the physicians still wanted to work in the private sector to make more money. They wanted to receive their care in the
private sector, because that care was "better".
What made the care better? The doctors and nurses had more time to see
patients, and they didn't need to wait a long time.
I wasn't certain I believed the professor that here
in Thailand things were different. Yes, Germany, Sweden, the United Kingdom,
Canada, and other very high income places have top notch national health care
systems. But Thailand? I knew they had great
doctors, but had assumed that outside of universities they migrated to the
private sector as well.
After seeing an Australian-Thai dual citizen who
flies back to Chiang Mai to get his health care at the government hospital
because he also thinks it is the best care he can get between the two
countries, I decided to talk to the Thai residents.
Fern responded quickly, "I want to work in a
government hospital." No hesitation.
"Why?" I asked.
"Because you get to see more interesting
patients. You see everyone. You see lots of poor people, so you see lots of
disease."
Ok. I can see that. That is part of why so many
people like working at Hennepin County Medical Center (HCMC) and the University
of Minnesota. You see cool things that
you just won't see other places. But what about for her own care? I continued,
asking, "Where do you want to go for your health care? Where will you go
if you get sick?"
"Here," she responded again without pause.
"The best doctors and nurses are here. I would want to be taken care of
here."
"Not at a private hospital?" I asked, just
to be sure.
"A hotel? No, no." Then she and the fellow began describing
private hospitals as places that pay more for the decorations and the
atmosphere than the medications and the doctors. Many of those places are for falangs (foreigners), and the care is
not as good as the care you can get through the government if you are Thai. So
why would you waste your money that way?
The overall impression was that it would be silly to go anywhere else.
I have a hard time picturing some of my wealthier
patients in Minnesota being willing to get their care at a Thai hospital. I
already had a suburban Minnesotan tell my attending that they would never get
their care at a place like HCMC. Thankfully, my attending responded by saying
that the patient would be lucky to get his care at HCMC if he had any disease
that needed more than the small community hospital where we were.
But maybe if people knew it is where the best
doctors were, if it were incentivized so that the best doctors wanted to work
there, a government system could work somewhere like Minnesota. I think it has potential, but I also think
it would be a hard pill for many Americans to swallow.
