1 / 19

International Trade and Movement of Health Professions: Experiences from the Health Sector in Thailand

This article explores the phenomenon of external brain drain in the health sector in Thailand, particularly the migration of medical doctors and nurses to developed countries. It discusses the various factors influencing brain drain, such as financial incentives and demand for continuing education. The article also highlights the strategies implemented to address brain drain, including compulsory public works, financial incentives, in-country specialty training, and increased production of health professionals. It emphasizes the need for holistic and integrated strategies to mitigate the negative effects of brain drain.

edwinbrock
Download Presentation

International Trade and Movement of Health Professions: Experiences from the Health Sector in Thailand

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. International Trade and Movement of Health Professions: Experiences from the Health Sector in Thailand Suwit Wibulpolprasert Deputy Permanent Secretary Ministry of Public Health, Thailand 11 April 2002

  2. External Brain-Drain • From developing countries in respond to demand for continuing education, financial incentives, and demand in developed countries. • Mainly medical doctors and nurses - high demand, good quality graduates, good command of English, biggest gap of income.

  3. Migration of M.D., Thailand Total graduates % external brain drain Year Emigrants 233 236 276 56 81 140 24.03 34.32 51.72 1963 1964 1965 745 37.18 Total 277

  4. Mainly to USA (~1,500 M.D.) • Rarely come back • Reduced greatly since1980 • Prompted many remedies: • 3 years compulsory public works • Financial incentives • In-country specialty training • Increase production - rural recruitment/placement • Social advocacy/incentives External Brain Drain (1960-1975)

  5. Compulsory Public Work • Started with MD graduates since 1972 - 3 years with the public sector, 2/3 to the rural district hospitals. • USD 12,000 fine, if breach contract. • Began with Pharmacists and Dentists in 1987. • Rapid expansion of rural hospitals and better distribution of personnel.

  6. Financial incentives • Started with hardship allowance for MD in the district hospitals since 1972 - $US80/month. • Increased in amount, categories and professions in respond to internal brain-drain since 1991. • No evaluation on their effectiveness.

  7. Monthly Remuneration of MoPH doctors working in rural hospitals in 2000 ($US) • Salary (new graduates) 200 • Non private practice 250 • On-call services 250-300 • Special procedures 70-130 • Special clinics 100-300 • Hardship allowances 50-500 Total 920-1,680

  8. In-country specialty training • Started by the Medical council since 1971, 3-5 years of training. • Thai board of medical specialties are granted - now 45 specialties. • Mainly start after 3 years of public work, except in rare specialties. • More than 2/3 of Thai M.D. are specialists.

  9. Percentage Year 1996 1998 Proportion of Medical Specialistsand General Practitioners, 1971-1999

  10. Annual output of medical doctors Number Rapid economic growth CPIRD (+300/yr) Compulsory public work Increase production (+340/yr) External brain drain Year

  11. Proportion of rural medical students Percentage CPIRD CPIRD = Collaborative Project to Increase Production of Rural Doctors Year

  12. Social Incentives • Rural Doctor Society (RDS) established in 1975 - self-help/advocacy civil society. • Bi-monthly rural doctor newsletters and journals published. • Annual best rural doctor award by the oldest medical school since 1976. • Hardship award by the RDS since 1982. • Career development - doctor in rural hospital can be promoted to the level of director of a division or deputy DG.

  13. Trade inFinancial services and internal brain-drain • 1992 - Established BIBF (Bangkok International Banking Facilities) with rapid influx of low interest tax free loans. • Mushrooming of private hospitals in big cities with massive migration of doctors from rural public hospitals. • April 1997, 21 district hospitals went on without a single full time doctor.

  14. Economic crisis (1997-now) • Bankruptcy of private hospitals-NPL • Reverse brain drain/H. systems reforms • New businesses - promotion of mode2 • Regular/Package services • Dental/dentures services • Health tour/long-stay • More FDI (mode3) on private hospitals

  15. Private doctors and beds in Thailand (1970-2000) Beds Doctors BIBF FDI Econ. Boom Year

  16. Inequitable distribution of doctor (1977-2001) Econ. boom Econ. crisis BIBF Ratio of doctor density Doctors/100 Bed Year

  17. Conclusion 1. External brain-drain may occurred unrelated to GATS commitment. However, GATS mode4 may sustain and facilitate it. 2. Mode2/3 and trade in other services may resulted in internal and external brain-drain. 3. Multiple integrated strategies, implemented seriously are needed to mitigate the problems.

  18. The way forwards • “We shall need a radically new manner of thinking if mankind is to survive” Albert Einstein • We need “Conscious revolution towards civilized globalization and international trade”

  19. Entry VISA Work Permit License - practice/premise Investments permit Finance - Insurance/Self Socio-Cultural * Effectiveness * Barrier to Mode 4 for health professionals * GATS can not reduce these barriers

More Related