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The motivations , progress, and implications of Liberalisation of Trade in Health Services in the ASEAN context. Cha-aim Pachanee Suwit Wibulpolprasert Ministry of Public Health, Thailand. Interest of ASEAN countries on regional trade in health services.

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The motivations, progress, and implications of Liberalisation of Trade in Health Services in the ASEAN context

Cha-aim Pachanee

Suwit Wibulpolprasert

Ministry of Public Health, Thailand



Countries that export health professionals
Countries that export health professionals services

  • The Philippines, Indonesia: countries can absorb only 30 percent of health graduate professions

  • Nurses from these countries are found working in the UK, US, Middle East

  • 9,000 of Philippino doctors attend nursing school, 3000 have been exported, 3000 in the process, 3000 in training.

  • Indonesia produces 40,000 nurses per year and can absorb only 5,000. The MoH established the Centre for Empowering of Profession and HRH for Foreign Countriesto facilitate nursing export

  • Want to liberalise Mode 4 to facilitate movement of health personnel


Mras in health services within asean
MRAs in health services within ASEAN services

  • MRAs focus on nursing and medical professionals

  • Final draft of MRAs on nursing has been agreed among negotiators

  • Not real MRA, more hurdles e.g. require 3 years of practices (currently not required) and have to conform with local regulations

  • Several barrier limiting MRA:

    • Different education standards and programmes

    • Different in the scope of nursing practice

    • Level of entry into nursing programme

    • Level of standardized nursing definitions

    • Continuing competence

    • Regulatory system and licensing of practice

    • Language barriers

    • Cultural sensitivities

  • Negotiators are from professional council and very conservative


The possible impacts of liberalization of health related services under afas
The possible impacts of liberalization servicesof health related services under AFAS

  • Mode 2 - revenue from foreign patients / a dual market structure / severe maldistribution of health resources / create internal brain drain & widened gap of salary.

  • Mode 3 - a tiered healthcare system and increasing inequality of services between urban and rural hospitals

  • Mode 4 - brain drain can  constraint the development of the national healthcare system.

  • change the provider-patient relationship from patron-client to contractual relationship.

  • foreign professionals can create oversupply and competition with local professionals.


Incoherent policies on servicesuniversal coverage of health insurance and promotion of international trade in health services in Thailand

Cha-aim Pachanee, Suwit WibulpolprasertHealthPolicy and Planning. 2006; 21: 310-318.


Projected Demand for Medical Doctors by Thai patients services

(1) Data from Health and Welfare Survey by National Statistical Office

(2) Projecting rate of future increase in Outpatient (OP) and In-patient (IP) visits by using average rate in the previous three biennial periods giving equal weight to each period.



Projected Demand for Medical Doctors by foreign patients 2001-2003

Total visits (OPD equiv.) require MD

(million)

(1) Figure from the survey by Ministry of Commerce plus 30 percent of the under-surveyed.

(2) Estimation with the assumption of increase at the rate of 18-20 percent per year

(3) Estimation with the assumption of increase at the rate of 14-16 percent per year

(4) Estimation with the assumption of increase at the rate of 10-12 percent per year

Conditions for projection:

1. IP visit is equal to 5 percent of OP visits and 20 times of OP workload

2. Every patient requires medical doctor

3. One medical doctor provides services to 10,000 – 12,000 OPD visits / year


Projected Demand for 2001-2003 MDby Foreign Patients in 2015 based on success of the International Trade Policy


Internal Brain Drain 2001-2003 of Medical Doctors


Responses from Thai Government 2001-2003

1. Supply Side Interventions

  • Increase production of medical graduates

  • Import of foreign medical doctors

  • Hiring of retired medical doctors

  • Compulsory public services

  • Provision of financial & non-financial incentives

2.Demand Side Interventions

  • Health promotion campaigns

  • Promotion of primary care


Further Research Questions 2001-2003

  • Growth of foreign patients

  • Trend of health care seeking behaviours among Thai patients

  • Workload of health personnel

  • Consequences and effectiveness of incentive schemes provided to health personnel


Recommendations
Recommendations 2001-2003

  • Strengthened national health care systems, including primary care system, coverage of health insurance particularly for the poor and underprivileged

  • Strengthen regulations of private health services and educational facilities eg. premise control, professional practice, quality assurance

  • Building research capacity to monitor consequences of trade liberalisation

  • Learning from the experiences of other regional trade agreements, e.g. the EU, the Caribbean


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