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Health Services and FTA

Health Services and FTA. Suwit Wibulpolprasert, Ministry of Public Health, Thailand, 2 September 2005. Border. CB. Services. Consumers (C). CA. Suppliers (S). CP. Services. Natural person. S. NP. 4 main categories of trade in services. Services Sector R elated to Health.

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Health Services and FTA

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  1. Health Services and FTA Suwit Wibulpolprasert, Ministry of Public Health, Thailand, 2 September 2005

  2. Border CB Services Consumers (C) CA Suppliers (S) CP Services Natural person S NP 4 main categories of trade in services

  3. Services Sector Related to Health Business - Health professions Finance - Health Insurance - Investment Loans Education - Training of HR Distribution - Drug retailing H & Social - Hospital/ambulance cares Travel - Epidemics Environment - Environmental Health

  4. Entry VISA Work Permit License - practice/premise Investments permit Finance - Insurance/Self Socio-Cultural * Effectiveness/satisfaction * Barrier to trade in health services

  5. Mode 1: Cross border trade on Health:INDIA

  6. REVENUE from e-Health- INDIA Revenue of the BPO Industry Estimates by ESC , 1999 ESC - Electronics & Computer Software Exports Promotions Council

  7. Mode 2: Number of foreign patients in Thailand, by country of origin, 2001-2003Source: Export Promotion Department (2004) Note: The number of foreign patients has been counted in term of revisit since 2003

  8. % increase of foreign patients 2000-2001 38% 2001-2002 14.5% 2002-2003 54.5%

  9. Percentage of foreign patients by region, 2001 Source: Service Trade Division, Department of Export promotion, Ministry of Commerce, 2002

  10. Mode 3: Commercial presence of Thai health providers abroad • Hospital management service • In 2003, Bumrungrad Hospital signed two 5-yr contracts with hospitals in Burma and Bangladesh. • In the last 10 yrs, Bangkok hospital has established 12 branches in Southeast Asia and South Asia – targetting tourist towns.

  11. Mode 3: Commercial presence of foreign health service providers in Thailand • Possibility of majority foreign share holders since 1999 • FDI in private hospitals in Thailand is very small, contributing <5% of total investment: Strong private sector and too good public services. Singapore is moving in. • AFAS requires 49:51 in 2006 and 70:30 in 2012

  12. Mode 4: Medical doctors and nurses working abroad • Massive outflow of medical doctors even without liberalisation agreement – between 1965-75 lost 1,500 doctors to the US, one fourth of all doctors • Much less outflow now due to high demand in the private sector and language limitation • Crisis in Africa, paradise for India and PL

  13. Mode 4: Foreign health personnel working in Thailand. • Very rare. • Need a license examination in Thai. • Temporary license for public or NGO services can be obtained through MoPH’s recommendation, e.g, working in remote areas. • AFAS: Mutual recognition – learn from EC

  14. Foreign practitioners received licenses in Thailand (1946-2003) Exam in Thai Number Year Source: Thai Medical Council

  15. Thailand’s Dual Tracks Policy • Universal Coverage of Health Insurance in 2001 and universal access to ARVs in 2003: Rapid increase in local demand • Medical Hub Policy since 2002: Rapid Influx of Foreign Patients • Competing for limited health resources particularly Human Resources

  16. Thailand Center of Excellent Health Care of Asia Vision for 2008 1. Medical Services 2. Health Promotion 3. Herbal Products Output

  17. Estimated Accumulated Income Estimated Accumulated Income = 4,051 m.EU. in 2008 Current estimated income = 502 m.EU.

  18. Strategies to promote mode 2: Foreign Patients to Thailand • Establishing excellence in specialist areas • Overcome language barriers • Service apartments for relatives of patients; • Health tourism package • Encourage referrals • Establish offices abroad. • Invest in modern medical equipments.

  19. Implications on Health Systems • Tiered Health Services • Brain drained: Virtual and Real - Virtual in Mode 1-3 - Real in Mode 4: Africa crisis • Cadre mix: Doctors to Nurses in Phillipines • Doctors-patients relationship

  20. Percent of Net Loss of Doctors (Resign-Reapply) as Compare to New Graduates, MoPH Foreign patents UC Percentage Economic crisis Year

  21. Responses • Increase production of doctors 10,000 in next 15 years • Increase incentives • Import of foreign doctors: Mode 4?

  22. Political Engagement • Constructive engagement with negotiators • Inform the implication on essential government policy, e.g. the universal coverage scheme, the universal access to ARVs • Negotiate for more health budget

  23. Networking among different sectors MOC MOF Ministry of Public Health WHO/HQ Permanent Secretary Office Hlth. Service Support Dept. Dept. of Trade Negotiation Dept. Export Promotion Fiscal Policy Research Institute RO Bureau of Policy& Strategy Div. Medical Registration Bureau of Trade in Services WRO Policy Unit Health Services Div. Service Business Div. Health Policy Unit National Health Assembly Informal Network Researchers Researchers Representatives IHPP Civil society Private Sector Universities HSRI

  24. Peace, Economic growth and Health Budget Percentage Year Source: Bureau of Budget

  25. National budget Health budget Health/National Budget 5,571.8 mil. ฿ (4.0%) 16,225.1 mil. ฿ (4.8%) 986.6 mil. ฿ (3.4%) 335,000 mil.฿ 140,000 mil.฿ 29,000 mil.฿ 1972 1981 1990 59,227.3 mil. ฿ (7.2%) 77,720.7 mil. ฿ (8.1%) 1,028,000 mil.฿ 825,000 mil.฿ 1999 2004

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