Building centres of excellence for expertise, training

Thailand's leading medical schools - including Siriraj, Ramathibodi, and Chulalongkorn hospitals - will invest Bt24 billion to develop medical centres of excellence and lift the Kingdom's research and services to compete with the international community.

At the same time, the Thailand Development Research Institute has warned medical schools they should not compete with the private sector for foreign patients - but focus instead on their role in teaching medical |students.

The Health System Research Institute (HSRI)'s director Dr Pongpisut Jongudomsuk has expressed concern over what he called double standards of treatment provided by medical schools for foreign and local patients, pointing out the increasing number of centres for medical excellence in medical schools.

These medical schools, he said, should concentrate on treating local people before seeking fee-paying foreign patients.

"We have to think about how to help medical schools develop a medical hub policy, but without causing a negative impact on the nation's health care system," he said.

Associate Professor Adisorn Patradul, dean of Chulalongkorn University's Faculty of Medicine, said the hospital had invested Bt12.5 billion to build a medical excellence centre and medical care building.

The medical excellence centre will treat complex diseases and conduct research to lift the standard of medical services. It will be housed in 13 floors of a new 29-storey building. The new building is expected to be operational in four years.

At present, the hospital's centres involve research into breast cancer, Parkinson's disease, cancer, thalassaemia, and stem cell research - which it sees as another treatment option for the future . Soon it will open centres for sleep disorders, endoscopic surgery, and accidents.

He said public services would be provided at the medical care and excellence centre, which will offer surgery, an intensive care unit and research centre.

The Bhor Por Ror building would also provide medical services for outpatients, while the Sirikit building would do surgery and treatment for heart disease and the brain. There would also be public medical services at the out-patient building.

At Ramathibodi Hospital, director Dr Rajata Rajatanavin said Bt6 billion would be invested to develop a faculty of medicine with the aim of making it a leading Asian hospital. It will be sited at Samut Prakan's Bang Phli district, where the Treasury Department has given 300 rai for construction.

Work will start in October with a 2015 completion date. It will operate as a referral and education centre, training medical students and specialists in all fields, including public health research into family medicine and occupational diseases related to industrial activities.

Rajata said many workers at industrial sites at Samut Prakan lacked treatment for occupational diseases.

Ramathibodi's Bang Phli branch will cover people in seven provinces in the east and act as a referral centre for patients with complex conditions for treatment at the hospital's head office on Rama VI.

Four years after construction, the Ramathibodi hospital's Bang Phli branch should have 400 beds. The hospital at Rama VI currently has 1,300.

Siriraj's medical faculty dean, Clinical Professor Teerawat Kulthanan said the hospital was spending Bt6 billion building a centre for medical research and services. It is expected to receive 1,500 to 2,000 patients a day and employ 1,700 medical staff.

The centre will conduct research in three areas: molecular, biogenetic and post genomic, to improve quality of medical services, medical products, and basic medical science research.

The centre will also serve at least 10 big research projects to try to attract international researchers to work on general and new or "emerging" diseases.

He said the operations of the centre would not affect regular medical services to patients at Siriraj Hospital. At present, over 2 million outpatients and 70,000 inpatients undergo treatment at Siriraj each year.

Teerawat said 45 per cent of Siriraj patients could afford to pay for treatment. Just 2 to 5 per cent were foreign. "There are no double standards for medical services at Siriraj," he commented.

The medical excellence centre would generate income from people who could afford expensive treatment, but the prices would be 30 to 40 per cent cheaper than those at private hospitals. The money would support medical care for poor patients.

Teerawat said the hospital had a shortage of nurses as many were leaving to work at private hospitals. It has asked the Faculty of Nursing to lift its number of graduates from 200 a year to 240. It has also requested nurses from the Royal Thai Navy.

Viroj na Ranong, a senior official at the Thailand Develop-ment Research Institute (TDRI), who conducted a study on the Thailand medical hub idea, said he approved of medical schools developing excellence centres - if the goal was to encourage workers for state hospitals.

He said medical schools should not compete with the private sector for foreign patients, but focus on their educational role in teaching medical students.

"They should not use public resources to provide medical services for foreign rather than domestic patients. This exceeds the role of medical schools supported by the government's budget," he said.

The medical hub policy was initiated in 2003 by the Thaksin government to generate income from medical services by providing treatment for foreign patients, with the country as Asia's medical centre.

A study conducted by TDRI found that 1.4 million foreign patients receive medical services at private hospitals in Thailand each year. This brought in an income of Bt46 to Bt52 billion from foreign patients in 2008.

However, the study suggested the medical hub policy might force medical workers, especially specialists at state hospitals, to work in private hospitals because of their higher salaries.

"Only newly graduated doctors will work at state hospitals to provide medical treatment to poor patients while specialists will head to private hospitals to treat rich patients. So, this will affect the nation's health security," Viroj warned.