The Rural Doctors Society (RDS) has

The Rural Doctors Society (RDS) has unveiled a "pay for quality and outcome (PQO)" scheme to rival the performance appraisal plan adopted by the government.
The proposed scheme was designed by the RDS and academics following talks between the group and the Public Health Ministry in June to resolve a dispute over how to revamp payments for rural doctors.
Rural doctors nationwide were called to a meeting in Bangkok yesterday to learn the details of the PQO.
President Kriangsak Watcharanukulkiat said yesterday the group preferred the PQO over the scheme adopted by the government.
The PQO takes into account the context in which rural doctors work, he said.
The ministry proposed a pay for performance scheme (P4P) earlier this year, but many rural doctors opposed it.
The society claimed the P4P scheme, which assesses performance mainly on a quantitative basis, would create a burden for medical staff because they would have to record their activities every day.
For example, under the P4P scheme a doctors' performance would be rated on the number of patients treated each day.
The P4P scheme would also create a competitive environment that could result in conflicts among medical staff and lead them to conduct only activities that gain high performance scores, the society argued.
The PQO avoids these pitfalls, said Dr Kriangsak. The scheme's performance scores are handed out to teams rather than individuals.
The performance indicators are mainly based on people's health.
Success would be judged on whether there had been a reduction in disease prevalence and deaths, he said.
For example, instead of ranking performance scores by the number of diabetes cases examined each day, the PQO is more focused on changing patients' behaviour to reduce blood sugar levels. Performance will be evaluated over months or a year, depending on the task being assessed.
"Performance can't be evaluated on a daily basis," Dr Kriangsak said. "If we do that, medical staff will be more concerned about the quantity of services rather than quality."
"In our context, we can't wait for people to come to us. We must go to them _ that's why a proposed P4P does not suit our tasks."
The Public Health Ministry plans to implement the P4P scheme from Tuesday. It is unknown at this stage if the ministry will consider the society's PQO alternative. But Dr Kriangsak insisted the RDS would stand behind the PQO.
Kanit Sangsubhan, Fiscal Policy Research Institute director and and chairman of the committee for compensation for health personnel, said the performance scheme must be a modern one that encourages efficiency. But the process of finding the right performance indicators is not easy, he said.
Wachira Pengjuntr, deputy permanent secretary for public health, attended the meeting with the RDS yesterday. He expressed his support for the society and said the performance indicators were key to deciding payments.
The conflict between the ministry and the society was the result of miscommunication. Now the two sides seem to have more common ground, he said.