Trade in Health Services… Good for Thailand ??? : Wattana S. Janjaroen 13-02-07 1 Trade in Health Services… Good for Thailand ??? Wattana S. Janjaroen, Ph.D.
Faculty of Economics
Chulalongkorn University
13 February 2007
Topics : Wattana S. Janjaroen 13-02-07 2 Topics Background
Potential of trade in health service sector
Consequences of trade in health services
What should we do?
Slide3 : Wattana S. Janjaroen 13-02-07 3 Wattana S. Janjaroen 13-12-00 3 GATT, WTO, AFTA , APEC TRIPS, GATS, LAW, REGULATION, ETC
Slide4 : Wattana S. Janjaroen 13-02-07 4 Summary of industry-specific commitments scheduled by Asia/Pacific
trading partners, by industry, under GATS.
Slide5 : Wattana S. Janjaroen 13-02-07 5 Wattana S. Janjaroen 13-12-00 5
Slide6 : Wattana S. Janjaroen 13-02-07 6
Slide7 : Wattana S. Janjaroen 13-02-07 7 1. CROSS - BORDER TRADE
2. CONSUMPTION ABROAD
3. COMMERCIAL PRESENCE
4. MOVEMENT OF PERSONNEL MODE OF SUPPLY
Slide8 : Wattana S. Janjaroen 13-02-07 8 Potential areas of trade in health services in Thailand
Consequences : Wattana S. Janjaroen 13-02-07 9 Consequences Impacts of trade in health services on national health sector using a framework of equity and quality.
Impacts of trade in health services on national health system
To explore the possibility of public sector competing in trade in health services and their implication on health system.
Research Methodology : Wattana S. Janjaroen 13-02-07 10 Research Methodology Research Design
Economic Tools
Research Design : Wattana S. Janjaroen 13-02-07 11 Research Design Cross-sectional Study : 2005
Target population : patients in private and public hospital with 300 bed + and hospital managers and experts
Sample size
Sampling method
Sample Size : Wattana S. Janjaroen 13-02-07 12 Sample Size
Where:
n = Number of items in samples
Z2 = The square of the confidence interval
in standard error units.
p = Estimated proportion of success = 0.6
q = (1-p) or estimated the proportion of failures = 0.4
E2 = The square of the maximum allowance for error
between the true proportion and sample proportion
= 576 ~ 600 samples
Sample hospitals : Wattana S. Janjaroen 13-02-07 13 Sample hospitals One private hospital each from the north, northeast, south and west region
Two private and two public hospitals in Bangkok
75 samples both outpatient and inpatient from each hospital
The samples were interviewed at their own willingness to participate.
Experts/hospital manager from each hospital
Economic tools : Wattana S. Janjaroen 13-02-07 14 Economic tools Descriptive statistics--- secondary data, questionnaires and in-depth interview
Logit model : data needed --- questionnaires
Concentration Index--- secondary data sources
Herfindahl Summary Index (HSI)
Comprehensive Concentration Index (CCI)
Entropy Index
Logit Model : Wattana S. Janjaroen 13-02-07 15 Logit Model Zi = + Xi
General form
Z = 0 + 1SEX + 2MARITAL + 3EDU + 4BUS + 5GOV + 6 PRIVATEIN + 7P1
+ 8P2 + 9P3 + 10P4 + 11P5 + 12P6
+ 13TIME
Slide16 : Wattana S. Janjaroen 13-02-07 16 Where :
Z = dummy variable indicating choice of services
Z = 1, if the patient uses a private hospital
Z = 0, if the patient uses a public hospital
SEX = dummy variable indicating patient’s gender
SEX = 1, if the patient was male
SEX = 0, if the patient was female
MARITAL = dummy variable indicating patient’s marital status
MARITAL = 1, if married
MARITAL = 0, if not married
EDU = dummy variable indicating level of education
EDU = 1, if patient’s education > bachelor degree
EDU = 0, if patient’s education < bachelor degree
Slide17 : Wattana S. Janjaroen 13-02-07 17
BUS = dummy variable indicating patient’s career
BUS = 1, if working in private sector
BUS = 0, if otherwise
GOV = dummy variable indicating patient’s government employment involvement
GOV = 1, if a full-time government employee
GOV = 0, if otherwise
PRIVATEIN = dummy variable indicating private health insurance benefit
PRIVATEIN = 1, if having private health insurance
PRIVATEIN = 0, if otherwise
P1 = dummy variable indicating rationale for choice
P1 = 1, if the patient had a contract with hospital
P1 = 0, if otherwise
P2 = dummy variable indicating rationale for choice
P2 = 1, if the patient was satisfied with the medical services
P2 = 0, if otherwise
P3 = dummy variable indicating rationale for choice
P3 = 1, if chosen for the medical experts’ skill P3 = 0, if otherwise
P4 = dummy variable indicating rationale for choice
P4 = 1, if recommended by others
P4 = 0, if otherwise
P5 = dummy variable indicating rationale for choice P5 = 1, if there was a good environment and service
P5 = 0, if otherwise
P6 = dummy variable indicating rationale for choice
P6 = 1, if the price of the service was though reasonable
P6 = 0, if otherwise
TIME = waiting time in receiving services
Slide18 : Wattana S. Janjaroen 13-02-07 18 Results
INTERNATIONAL TOURIST ARRIVALS TO THAILAND BY NATIONALITY : Wattana S. Janjaroen 13-02-07 19 INTERNATIONAL TOURIST ARRIVALS TO THAILAND BY NATIONALITY Source of data : Immigration Bureau, Police Department
Slide20 : 20 Wattana S. Janjaroen 13-02-07
Concentration index : number of bed in each province : Wattana S. Janjaroen 13-02-07 21 Concentration index : number of bed in each province
Impacts on health system and medical education : Wattana S. Janjaroen 13-02-07 22 Impacts on health system and medical education Negatives
Inequities in access to health care in Thailand would inevitably increase, since there is high competition among health providers to attract the high-end segment of the market, driving the cost of these services upward and hence the prices to be paid, which inhibits domestic inhabitants at relatively lower income levels from gainful access to health care services. The waiting time prior to receiving health services at public hospitals is much longer than that at private hospitals.
There is a problem of ‘brain drain’ of health personnel from public establishments to private hospitals and between private hospitals, especially doctors. This situation increasingly disadvantages lower-income Thai citizens from accessing good quality domestic health care services. The ‘brain drain’ problem is extending to professors at medical schools. This phenomenon is greatly impacting the quality of medical education in the short- and long-terms.
There is some inequity in payment for the same services that occurs mainly at public hospitals. Foreign non-resident patients may pay less on the whole for health services when compared to Thai citizenry because they may not be contributing directly to the government budget through taxation as Thai nationals and foreign legal residents are required to.
Slide23 : Wattana S. Janjaroen 13-02-07 23 Resignation Rate of Medical Professors, 2002-2004
Slide24 : Wattana S. Janjaroen 13-02-07 24 Positive
Trade in health services can earn hard currency for the country that undertakes international marketing of health services, where external demand for health care and health-related business can help reduce national trade deficits, or supplement surpluses.
There could be a mutual cross-subsidization between the public and private health service sectors via part-time employment of qualified health personnel from the public sector at private hospitals, augmenting the incomes of public sector health service professionals, while not having to totally abandon their duties at public hospitals.
The health care service market, especially in large urban centers, is a competitive one. The quality of health services may be improved by competition in meeting more lucrative demand implied by the international market.
Potential of public hospital in trade in health services : Wattana S. Janjaroen 13-02-07 25 Potential of public hospital in trade in health services Less likely :
- restriction on government policy, budget
- need big investment on health personnel, especially
on ability to communicate with foreigners
- objectives is maximize health of Thai
Recommendations : Recommendations Wattana S. Janjaroen 13-02-07 26
Slide27 : Wattana S. Janjaroen 13-02-07 27
Slide28 : Wattana S. Janjaroen 13-02-07 28