Panel A:

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Health Beyond Borders Healthcare Challenges in
ASEAN and Issues Concerning Health
Professionals St. Lukes Medical Center August 24,
2015
Healthcare Professionals Issues
Jose Y. Cueto Jr., MD, FPCS, FPSGS,
MHPEd Dean MMSU College of Medicine
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ASEAN ECONOMIC COMMUNITY
Competitive Economic Region
EquitableEconomic Development
Integration into the Global Economy
Single Market and Production Base
1. Free Flow of Goods 2. Free Flow of Services
3. Free Flow of Investment 4. Free Flow of
Capital 5. Free Flow of Skilled Labor 6.
Priority Integration Sectors 7. Food,
Agriculture and Forestry
1. Competition Policy 2. Consumer Protection
3. Intellectual Property Rights 4.
Infrastructure Development 5. Taxation 6.
E-Commerce
1. SME Development 2. Initiative for ASEAN
Integration
1. Coherent approach towards external economic
relations 2. Enhanced participation in global
supply networks
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The ASEAN MRAs
PROFESSIONAL SERVICES DATE / PLACE OF SIGNING
1. ENGINEERING 9 Dec. 2005 Kuala Lumpur, Malaysia
2. NURSING 8 Dec. 2006 Cebu, Philippines
3. SURVEYING 19 Nov. 2007 Singapore
4. ARCHITECTURE 19 Nov. 2007 Singapore
5. DENTISTRY 26 Feb. 2009 Cha-am, Thailand
6. MEDICINE 26 Feb. 2009 Cha-am, Thailand
7. ACCOUNTANCY 26 Feb. 2009 Cha-am, Thailand

8. TOURISM 9 Nov. 2012 Bangkok, Thailand
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ASEAN Framework Agreement on Services Article V

• ASEAN Member States may recognize the education
  or experience obtained, requirements met, or
  licenses or certifications granted in another
  ASEAN Member State, for the purpose of licensing
  or certification of service suppliers

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Objectives of the MRA for Health Practitioners

• 1. Facilitate mobility of health practitioners
  within ASEAN
• 2. Exchange information and enhance cooperation
  in respect of mutual recognition of health
  practitioners
• 3. Promote adoption of best practices on
  standards and qualifications
• 4. Provide opportunities for capacity building
  and training of health practitioners

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Recognition and Eligibility of Foreign Health
Practitioners

• 1. In possession of a qualification recognized by
  PRA of country of origin and host country
• 2. In possession of a valid professional
  registration and current practising certificate
  to practice profession issued by PRA of country
  of origin
• 3. Has been in active practice in country of
  origin
• Dentistry 5 years
• Medicine 5 years
• Nursing 3 years

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Recognition and Eligibility of Health
Practitioners

• 4. In compliance with CPD requirements
• 5. Has been certified as not having violated any
  professional or ethical standards, local and
  international
• 6. Has declared that there is no investigation or
  legal proceeding pending against him/her in the
  country of origin or another country
• 7. In compliance with any other assessment or
  requirement as may be imposed by host country

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Professional Medical Regulatory Authority (PMRA
or PRA)
ASEAN Member States PMRA / PRA
Brunei Darussalam Brunei Medical Board
Cambodia Cambodian Medical Council / Ministry of Health
Indonesia Indonesian Medical Council / Ministry of Health
Lao PDR Ministry of Health
Malaysia Malaysian Medical Council
Myanmar Myanmar Medical Council / Ministry of Health
Philippines Professional Regulation Commission Professional Regulatory Board of Medicine
Singapore Singapore Medical Council Specialists Accreditation Board
Thailand Thailand Medical Council Ministry of Public Health
Vietnam Ministry of Health
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• V. Services, unlike goods, have 4 modes of supply

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Modes of Supply
COUNTRY A
COUNTRY B
Mode 1 Cross border supply
Consumer A
Service Supplier
The service crosses the border
Mode 2 Consumption abroad
Service Supplier
Consumer A
Consumer A
Service
supply
Mode 3 Commercial presence
Consumer A
Service Supplier
Commercial Presence
Establishes a commercial presence in A
Service
supply
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Modes of Supply
COUNTRY A
COUNTRY B
Mode 4 Movement of natural persons
Consumer A
Self-employed goes to Member A
Service
supply
Naturalperson
Naturalperson
Employee sent by firm from B
Consumer A
Commercial Presence
Service
supply
Juridical person
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AEC 2015
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Challenges

• 1. Variation in qualification requirements across
  borders

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Medical Education Data
COUNTRY DURATION DEGREE CONFERRED
Indonesia 5 years MD
Malaysia 5 years MBBS
Philippines 5 years MD
Singapore 6 years MBBS
Thailand 6 years MD
Vietnam 6 years MD
Lao PDR 6 years MD
Myanmar 7 years
Cambodia 8 years Diploma of Medical Doctor
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Comparability of ASEAN Nursing programs (Basic
Nursing Education)
COUNTRY NO. OF YEARS DIPLOMA/DEGREE
Brunei Darussalam 3 years 4 years Diploma in Health Science (Nursing) Bachelor of Health Science (Nursing)
Cambodia 3 years 4 years Associate Degree in Nursing Bachelor Science Nursing
Lao PDR 3 years 2.5 years 4 years Diploma in Nursing Continuing Bachelor in Nursing Science (Upgrade from diploma) Bachelor Science in Nursing
Indonesia 3 years 4 years Diploma in Nursing Bachelor in Nursing
Malaysia 3 years 4 years Diploma in Nursing Bachelor Science in Nursing
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Comparability of ASEAN Nursing programs (Basic
Nursing Education)
COUNTRY NO. OF YEARS DIPLOMA/DEGREE
Myanmar 3 years 4 years Diploma in Nursing Bachelor of Nursing Science
Philippines 4 years Bachelor of Science in Nursing (BSN)
Thailand 2 years 4 years BSN for Associate Diploma Nurses Bachelor of Science in Nursing (BSN)
Singapore 3 years 12 months 3 years/4 years Diploma in Nursing Bachelor of Science Conversion Program for RNs Bachelor of Science (Nursing)/(Hounors)
Vietnam 2 years full time 3 years full time 4 years full time 4 years part time Certificate Nurse Junior BsN (College of Nurse) Senior, BsN (Bachelor of Nursing Science) Bachelor of Nursing
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Challenges

• 1. Variation in qualification requirements across
  borders
• 2. Differences in religion and culture

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Religion
RELIGION COUNTRY / COUNTRIES
Buddhist Cambodia Lao PDR Myanmar Thailand Vietnam
Muslim Brunei Indonesia Malaysia
Catholic (predominant) Philippines
Diverse Singapore
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Challenges

• 1. Variation in qualification requirements across
  borders
• 2. Differences in religion and culture
• 3. Differences in language and difficulty in
  communication

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Language

• Healthcare involves person-person interaction
• Licensure examinations in native language
• For Filipino health professionals, proficiency
  in English, which is an added advantage in going
  to traditional destinations, may not be an
  advantage in the ASEAN

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Challenges

• 1. Variation in qualification requirements across
  borders
• 2. Differences in religion and culture
• 3. Differences in language and difficulty in
  communication
• 4. Mismatch in available and needed health
  professional

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(No Transcript)
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Health Professions
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Labor Market Conditions

• Quantity
• Quality
• Distribution
• Surpluses?
• Shortages?
• Actual needs?

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Number of Schools / Graduates
Profession Number of Schools Number of Graduates/Year
1. Dentistry 26 1,210
2. Medical Technology 76 1,600
3. Medicine 42 4,500
4. Midwifery 252 7,380
5. Nursing 491 ----301 89,000
6. Nutrition and Dietetics 36 484
7. Optometry 9 100
8. Pharmacy 80 3,000
9. Physical/Occupational Therapy 90 725
10. Radiologic Technology 69 2,000
11. Respiratory Therapy 16 321
12. Veterinary Medicine 20 380
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Number of Registered Professionals
Profession Passing Percentage Number of Professionals
1. Dentistry 41.8 27,999
2. Medical Technology 77.0 30,891
3. Medicine 70.4 70,418
4. Midwifery 43.9 73,682
5. Nursing 41.3 526,897
6. Nutrition and Dietetics 67.0 6,834
7. Optometry 66.0 4,778
8. Pharmacy 52.2 35,912
9. Physical/Occupational Therapy 51.5 13,202
10. Radiologic Technology 48.0 8,678
11. Respiratory Therapy
12. Veterinary Medicine 35.0 4,496
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Challenges

• 1. Variation in qualification requirements across
  borders
• 2. Differences in religion and culture
• 3. Differences in language and difficulty in
  communication
• 4. Mismatch between available and needed health
  professional
• 5. Adjustment to local rules/regulations
• 6. Acceptance by local practitioners

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Way Forward

• CHALLENGES
• Qualifications
• Religion
• Culture
• Language
• Mismatch
• Local rules
• Acceptance

HEALTHCARE PROFESSIONALS
HOST COUNTRIES
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Consequences of Influx of Professionals
Favorable
Unfavorable
1. Elevation of professional standards 1. Displacement of locals
2. Transfer of knowledge and skills 2. Wage/salary inequality
3. Transfer of technology 3. Rigid competition
4. Elimination of in-breeding 4. Downgrading of quality standards
5. Job generation 5. More expensive services
6. Solve maldistribution 6. Problem in maintenance of labor standards
7. Encourage teamwork and collaboration between local and foreign health professionals
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Form of Mobility
Limited Practice
Expert Visit
PMRA Qualification Recognition Process
PMRA Confer Temporary Registration Licensing
ASEAN Medical Practitioners
Education Training
Research
Humanitarian Missions
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Engagement of Stakeholders
Dissemination
Engagement
Professional Regulatory Authorities
Professionals / Professional Organizations
Educational and Healthcare Institutions
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Summary
ASEAN Integration
Regional Standards
Professional Practice
Continuing Professional Development
Basic Qualification
Postgraduate Qualification
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Summary
ASEAN Integration
ASEAN MRA Mobility
Labor Market Conditions
Engagement of Stakeholders
Comparability Studies
Identification of Challenges
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The Future

• Surgeons from Cambodia and Thailand
• Anesthesiologist from Malaysia
• Nurses from Indonesia and Philippines
• Operating room in Cambodia

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• THANK YOU
• FOR YOUR
• KIND ATTENTION!
• email jcuetomd_at_gmail.com