Health Services and FTA SuwitWibulpolpraset

Health Services and FTA: 

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

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4 main categories of trade in services

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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

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Barrier to trade in health services

Mode 1: Cross border trade on Health:INDIA: 

Mode 1: Cross border trade on Health:INDIA

REVENUE from e-Health- INDIA: 

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

Mode 2: Number of foreign patients in Thailand, by country of origin, 2001-2003 Source: Export Promotion Department (2004): 

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

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

Percentage of foreign patients by region, 2001: 

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

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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.

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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

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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

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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

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

Thailand’s Dual Tracks Policy: 

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

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Vision for 2008 1. Medical Services 2. Health Promotion 3. Herbal Products Output

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

Strategies to promote mode 2: Foreign Patients to Thailand : 

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.

Implications on Health Systems: 

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

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

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

Political Engagement: 

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

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Networking among different sectors

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

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