International Trade and Movement of Health Professions:

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
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.

3
Migration of M.D., Thailand
Total graduates
external brain drain
Year
Emigrants
233 236 276
56 81 140
24.03 34.32 51.72
1963 1964 1965
Total
277
745
37.18
4
External Brain Drain (1960-1975)
5
Compulsory Public Work

• 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.

6
Financial incentives

• 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.

7
Monthly Remuneration of MoPH doctors working in
rural hospitals in 2000 (US)

• Salary (new graduates) 200
• Non private practice 250
• On-call services 250-300
• Special procedures 70-130
• Special clinics 100-300
• Hardship allowances 50-500
• Total 920-1,680

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.

9
Proportion of Medical Specialistsand General
Practitioners, 1971-1999
10
(No Transcript)
11
(No Transcript)
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.

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.

14
Economic crisis (1997-now)

• Bankruptcy of private hospitals-NPL
• Reverse brain drain/H. systems reforms
• New businesses - promotion of mode2

• Regular/Package services
• Dental/dentures services
• Health tour/long-stay

• More FDI (mode3) on private hospitals

15
(No Transcript)
16
(No Transcript)
17
Conclusion
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.
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

19
Barrier to Mode 4 for health professionals
GATS can not reduce these barriers