Presentation on theme: "Dr.Suwit Wibulpolprasert 1 International Trade and Movement of Health Professions: Experiences from the Health Sector in Thailand Suwit Wibulpolprasert."— Presentation transcript:
Dr.Suwit Wibulpolprasert 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
Dr.Suwit Wibulpolprasert 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.
Dr.Suwit Wibulpolprasert 3 Year Emigrants Total graduates % external brain drain 1963 1964 1965 56 81 140 233 236 276 24.03 34.32 51.72 Total277 74537.18 Migration of M.D., Thailand
Dr.Suwit Wibulpolprasert 4 External Brain Drain (1960-1975) l Mainly to USA (~1,500 M.D.) l Rarely come back l Reduced greatly since1980 l Prompted many remedies: u 3 years compulsory public works u Financial incentives u In-country specialty training u Increase production - rural recruitment/placement u Social advocacy/incentives
Dr.Suwit Wibulpolprasert 5 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. Compulsory Public Work
Dr.Suwit Wibulpolprasert 6 Started with hardship allowance for MD in the district hospitals since 1972 - $US80/month. Increased in amount, categories and professions in respond to internal brain-drain since 1991. No evaluation on their effectiveness. Financial incentives
Dr.Suwit Wibulpolprasert 7 Monthly Remuneration of MoPH doctors working in rural hospitals in 2000 ($US) Salary (new graduates)200 Non private practice250 On-call services250-300 Special procedures 70-130 Special clinics 100-300 Hardship allowances 50-500 Total920-1,680
Dr.Suwit Wibulpolprasert 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.
Dr.Suwit Wibulpolprasert 9 Proportion of Medical Specialists and General Practitioners, 1971-1999 Year Percentage 1996 1998
Dr.Suwit Wibulpolprasert 10 Annual output of medical doctors Year Number Rapid economic growth CPIRD (+300/yr) Increase production (+340/yr) External brain drain Compulsory public work
Dr.Suwit Wibulpolprasert 11 Proportion of rural medical students Year Percentage CPIRD = Collaborative Project to Increase Production of Rural Doctors CPIRD
Dr.Suwit Wibulpolprasert 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.
Dr.Suwit Wibulpolprasert 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.
Dr.Suwit Wibulpolprasert 14 Economic crisis (1997-now) Bankruptcy of private hospitals-NPL Reverse brain drain/H. systems reforms New businesses - promotion of mode2 l Regular/Package services l Dental/dentures services l Health tour/long-stay More FDI (mode3) on private hospitals
Dr.Suwit Wibulpolprasert 15 Private doctors and beds in Thailand (1970-2000) Y ear Beds Doctors Econ. Boom BIBF FDI
Dr.Suwit Wibulpolprasert 16 Inequitable distribution of doctor (1977-2001) Year Doctors/100 Bed Ratio of doctor density Econ. boom BIBF Econ. crisis
Dr.Suwit Wibulpolprasert 17 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. Conclusion
Dr.Suwit Wibulpolprasert 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
Dr.Suwit Wibulpolprasert 19 Barrier to Mode 4 for health professionals Entry VISA Work Permit License - practice/premise Investments permit Finance - Insurance/Self Socio-Cultural * Effectiveness * * GATS can not reduce these barriers