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International Trade and Movement of Health Professions:

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. External Brain-Drain.

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International Trade and Movement of Health Professions:

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  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 745 37.18 Total 277

  4. Mainly to USA (~1,500 M.D.) • Rarely come back • Reduced greatly since1980 • Prompted many remedies: • 3 years compulsory public works • Financial incentives • In-country specialty training • Increase production - rural recruitment/placement • Social advocacy/incentives 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. Percentage Year 1996 1998 Proportion of Medical Specialistsand General Practitioners, 1971-1999

  10. Annual output of medical doctors Number Rapid economic growth CPIRD (+300/yr) Compulsory public work Increase production (+340/yr) External brain drain Year

  11. Proportion of rural medical students Percentage CPIRD CPIRD = Collaborative Project to Increase Production of Rural Doctors Year

  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. Private doctors and beds in Thailand (1970-2000) Beds Doctors BIBF FDI Econ. Boom Year

  16. Inequitable distribution of doctor (1977-2001) Econ. boom Econ. crisis BIBF Ratio of doctor density Doctors/100 Bed Year

  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. Entry VISA Work Permit License - practice/premise Investments permit Finance - Insurance/Self Socio-Cultural * Effectiveness * Barrier to Mode 4 for health professionals * GATS can not reduce these barriers

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