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Regulating the Movement of Doctors –Supply and Demand: The Philippines Jaime Z. Galvez Tan MD, MPH Professor, University of the Philippines College of.

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Presentation on theme: "Regulating the Movement of Doctors –Supply and Demand: The Philippines Jaime Z. Galvez Tan MD, MPH Professor, University of the Philippines College of."— Presentation transcript:

1 Regulating the Movement of Doctors –Supply and Demand: The Philippines Jaime Z. Galvez Tan MD, MPH Professor, University of the Philippines College of Medicine College of Medicine

2 Health Human Resources: The No. 1 Philippine Health Export No. 1 exporter of NURSES An estimated 85 percent of employed Filipino nurses (Aiken et al. 2004) (more than 150,000) are working internationally. (Aiken et al. 2004) (Bach, 2003) 70 per cent of all Filipino nursing graduates are working overseas (Bach, 2003) No. 2 exporter of DOCTORS (Mejia, WHO, 1979) 68 per cent of Filipino doctors work overseas, next to India. (Mejia, WHO, 1979)

3 The Diaspora of Filipino Doctors Filipino Doctors are practicing in at least 80 countries in the world Filipino Doctors are practicing in at least 80 countries in the world Majority are in the USA Majority are in the USA Others are in the Middle East, Pacific Island countries, Africa, Southeast Asia, Australia, New Zealand, Canada, Taiwan, Europe Others are in the Middle East, Pacific Island countries, Africa, Southeast Asia, Australia, New Zealand, Canada, Taiwan, Europe

4 The Out-of-the-Box Phenomenon in the Philippines Doctors have been becoming Nurses in the last 7 years Doctors have been becoming Nurses in the last 7 years At a rate of 1,200 per year, at least 9,000 Doctors are now MDs-RNs or Nursing Medics At a rate of 1,200 per year, at least 9,000 Doctors are now MDs-RNs or Nursing Medics At least 6,000 Doctors are now in the USA working as Nurses At least 6,000 Doctors are now in the USA working as Nurses

5 Schools for Nursing Medics At least 45 Philippine nursing schools offer abbreviated 1 ½- to 3-year courses for doctors to become nurses At least 45 Philippine nursing schools offer abbreviated 1 ½- to 3-year courses for doctors to become nurses Classes are every weekend; enrolment ranges from 50 to 500 doctors Classes are every weekend; enrolment ranges from 50 to 500 doctors Doctors go through the capping ceremonies and nursing duties in hospitals Doctors go through the capping ceremonies and nursing duties in hospitals The total tuition costs range from US$1,500 to US$3,500 The total tuition costs range from US$1,500 to US$3,500 Source: Source: Key Informant Interviews; Preliminary results, Galvez Tan, et al., 2004

6 Nursing Medics: Who Are They? They come from all kinds of specialties They come from all kinds of specialties Their age range from 25 years old to 65 years old Their age range from 25 years old to 65 years old Years of practice as a physician range from zero to 40 years Years of practice as a physician range from zero to 40 years Near equal male and female ratios Near equal male and female ratios They come from all regions of the country They come from all regions of the country Around 80% of public health physicians have taken up or are enrolled in nursing Around 80% of public health physicians have taken up or are enrolled in nursing Source: Source: KII, Personal Study 2004

7 Nursing Medics in the Philippines WHY THE SHIFT IN CAREER?

8 Nursing Medics in the Philippines WHY THE SHIFT IN CAREER? TOP 5 REASONS ON CAREER SHIFT TO NURSING 1Political instability 2Poor working conditions 3Threat of malpractice law 4Low salary and compensation 5Peace and order problem (Based on key informant survey results)

9 Nursing Medics in the Philippines PULL FACTORS OF NORTHERN COUNTRIES TOP 3 FACTORS INFLUENCING THEIR DECISIONS TO LEAVE 1More socio-politico- economic security abroad (Migrant visas for nurses & spouses & children) 2 Attractive salaries and compensation packages (High salaries, benefits, compensation) 3 More job opportunities and career growth (Based on key informant survey results)

10 The Supply of Doctors in the Philippines There are 36 medical schools (only 7 are government-run) There are 36 medical schools (only 7 are government-run) 2,000 doctors annually pass the Philippine National Licensure Exams (out of 3,000 that graduate yearly) 2,000 doctors annually pass the Philippine National Licensure Exams (out of 3,000 that graduate yearly) However in the last 3 years, there has been a 50% decrease in medical school enrolment However in the last 3 years, there has been a 50% decrease in medical school enrolment

11 The Demand for Doctors in the Philippines There are 120 rural municipalities that have been doctor-less for a decade or more There are 120 rural municipalities that have been doctor-less for a decade or more There are 600 vacancies in rural and urban hospitals (public and private) There are 600 vacancies in rural and urban hospitals (public and private) In the last 3 years, there has been a 30% decrease enrolment in hospital residency specialty training programs In the last 3 years, there has been a 30% decrease enrolment in hospital residency specialty training programs

12 Consequences of the Mass Migration of Filipino Doctors and Nurses

13 Positive and Negative Consequences Increase in US$ remittances from US$6 Billion in 2000 to US$10.2 Billion in 2005 (Source: Central Bank of the Philippines 2006) Increase in US$ remittances from US$6 Billion in 2000 to US$10.2 Billion in 2005 (Source: Central Bank of the Philippines 2006) However, little of these remittances are returned as investments in health nor in health human resources development However, little of these remittances are returned as investments in health nor in health human resources development Decrease in the proportion of deaths medically attended from 50% in 1995 to 30% in 2003 (Source: National Statistics Office 2006) Decrease in the proportion of deaths medically attended from 50% in 1995 to 30% in 2003 (Source: National Statistics Office 2006)

14 Source: National Statistics Office, 2006

15 Negative Consequences 200 hospitals have closed down within the past two years – no more doctors and nurses (PHA, November 2005) 200 hospitals have closed down within the past two years – no more doctors and nurses (PHA, November 2005) 800 hospitals have partially closed (with one to two wards closed) – lack of doctors and nurses (PHA, November 2005) 800 hospitals have partially closed (with one to two wards closed) – lack of doctors and nurses (PHA, November 2005)

16 Decreasing Trend in NMAT (National Medical Admission Test) Examinees since Yr Less and less young Filipinos wanting to become medical doctors with a decrease by 53% of NMAT Examinees since Year 2000 from 6,245 to 2,912 in 2005, the lowest in 12 years.

17 What has been the response of the Philippines? #1 Develop Health Business Models that will generate foreign investments in health ( the aim is for Filipino health professionals in the Philippines to earn foreign currency while practicing in the country ) Develop Health Business Models that will generate foreign investments in health ( the aim is for Filipino health professionals in the Philippines to earn foreign currency while practicing in the country )

18 Philippine Response #1.1 Medical tourism has been launched as a flagship program of the government in January 2006 Medical tourism has been launched as a flagship program of the government in January 2006 The Department of Foreign Affairs has commissioned the design of business models for health: (1) creation of an international zone of health for health and wellness combining medical tourism, spa health, eco-tourism and retirement villages (2) health human resources development network with the top nursing and medical schools/hospitals in the Philippines as investment areas (3) health crewing for specific health services, including tele-health, medical transcriptions, health research and development The Department of Foreign Affairs has commissioned the design of business models for health: (1) creation of an international zone of health for health and wellness combining medical tourism, spa health, eco-tourism and retirement villages (2) health human resources development network with the top nursing and medical schools/hospitals in the Philippines as investment areas (3) health crewing for specific health services, including tele-health, medical transcriptions, health research and development

19 Philippine Response #2 Increase physician scholarships in underserved areas with 200 new scholars starting 2006 Increase physician scholarships in underserved areas with 200 new scholars starting 2006 The Philippine Health Insurance Corporation is considering doubling reimbursements for physicians practicing in rural areas The Philippine Health Insurance Corporation is considering doubling reimbursements for physicians practicing in rural areas

20 Philippine Response #3 The Development Bank of the Philippines is designing a US$40 M program to provide low interest loans to physicians intending to practice in rural areas The Development Bank of the Philippines is designing a US$40 M program to provide low interest loans to physicians intending to practice in rural areas Legislation of a National Service Act Legislation of a National Service Act Development of a coherent Health Human Resource Development Policy Development of a coherent Health Human Resource Development Policy

21 Philippine Response #4 Recently updated the 25 year Master Plan for Health Human Resources Development ( ) by the Dept. of Health with the National Institutes of Health-Philippines and WHO Recently updated the 25 year Master Plan for Health Human Resources Development ( ) by the Dept. of Health with the National Institutes of Health-Philippines and WHO

22 Philippine Response #5 (private sector/civil society) The Philippine Medical Association held a Philippine Medical Summit in Sept 2005 for resolute actions on the issue The Philippine Medical Association held a Philippine Medical Summit in Sept 2005 for resolute actions on the issue The Philippine College of Physicians launched its campaign for retention of doctors in the Philippines through the Movement of Idealistic and Nationalistic Doctors (MIND) in 2005 The Philippine College of Physicians launched its campaign for retention of doctors in the Philippines through the Movement of Idealistic and Nationalistic Doctors (MIND) in 2005

23 What Else Needs to Be Done by the Philippines? Tame the mass exodus to the North Tame the mass exodus to the North Achieve a rational programmed departure or our health professionals Achieve a rational programmed departure or our health professionals Secure a win-win situation for the Philippines and the receiving countries Secure a win-win situation for the Philippines and the receiving countries Achieve brain gain and brain circulation for Filipino health professionals abroad Achieve brain gain and brain circulation for Filipino health professionals abroad Note: These do not aim to prevent health professionals from leaving the country Note: These do not aim to prevent health professionals from leaving the country

24 One: Initiation of High- level Bilateral Negotiations with Northern Countries Importing Filipino Health Professionals (similar to the South Africa-UK and Poland-Netherlands Agreement)

25 One … The Government should negotiate with the top importing countries for bilateral agreements that can lead to development of a National Trust Fund for Health Human Resource Development to help improve training, education and working conditions of local health workers, provide scholarships and even salary incentives. The Government should negotiate with the top importing countries for bilateral agreements that can lead to development of a National Trust Fund for Health Human Resource Development to help improve training, education and working conditions of local health workers, provide scholarships and even salary incentives.

26 Two: Convene the health human resources development agenda of the General Agreement on Trade and Services (GATS) of the World Trade Organization (WTO)

27 Two: Health services and health professional services can be treated like commercial goods and services that can be traded across and among countries in need of additional health care services. It is in the interest of physicians to be represented in the WTO negotiations.

28 Three: Joint Research Agenda Forge a joint or multi-country research agenda and action program on health human resources development among importing and exporting countries Forge a joint or multi-country research agenda and action program on health human resources development among importing and exporting countries At the very least there should be a partnership in the regular sharing of health human resources data and policies among these countries At the very least there should be a partnership in the regular sharing of health human resources data and policies among these countries

29 Finally: A Call of the Philippines to the Receiving Countries Create Health Human Resource Development (HHRD) policies that would be humane and compassionate to the Philippines Create Health Human Resource Development (HHRD) policies that would be humane and compassionate to the Philippines Increase bilateral aid specific for HHRD in the Philippines Increase bilateral aid specific for HHRD in the Philippines Encourage private investors in your country in invest in health in the Philippines Encourage private investors in your country in invest in health in the Philippines Enact legislation on ethical recruitment of health professionals Enact legislation on ethical recruitment of health professionals

30 The Challenge for All The need for global and national solidarity Matched by political will and action The time to act was yesterday.

31 Thank You Very Much!!! As we say in the Philippines, Mabuhay and Salamat Po Jaime Z. Galvez Tan MD, MPH


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