Healthcare Professionals: Issues

1. 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

2. 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

3. The ASEAN MRAs

4. 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

5. 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

6. 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

7. 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

8. Professional Medical Regulatory Authority (PMRA or PRA)

9. V. Services, unlike goods, have 4 modes of supply

10. 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 Consumer A Consumer A Service Supplier Service supply Mode 3: Commercial presence Consumer A Commercial Presence Service Supplier Service Establishes a commercial presence in A supply

11. 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

12. AEC 2015

13. Challenges 1. Variation in qualification requirements across borders

14. Medical Education Data

15. Comparability of ASEAN Nursing programs (Basic Nursing Education)

16. Comparability of ASEAN Nursing programs (Basic Nursing Education)

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

18. Religion

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

20. 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

21. 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

23. Health Professions

24. Labor Market Conditions Quantity Quality Distribution Surpluses? Shortages? Actual needs?

25. Number of Schools / Graduates

26. Number of Registered Professionals

27. 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

28. Way Forward • CHALLENGES • Qualifications • Religion • Culture • Language • Mismatch • Local rules • Acceptance HEALTHCARE PROFESSIONALS HOST COUNTRIES

29. Consequences of Influx of Professionals Favorable Unfavorable

30. Form of Mobility Limited Practice Expert Visit PMRA Qualification Recognition Process PMRA Confer Temporary Registration Licensing ASEAN Medical Practitioners Education Training Research Humanitarian Missions

31. Engagement of Stakeholders Dissemination Engagement Professional Regulatory Authorities Professionals / Professional Organizations Educational and Healthcare Institutions

32. Summary ASEAN Integration Regional Standards Professional Practice Continuing Professional Development Basic Qualification Postgraduate Qualification

33. Summary ASEAN Integration ASEAN MRA: Mobility Labor Market Conditions Engagement of Stakeholders Comparability Studies Identification of Challenges

34. The Future • Surgeons from Cambodia and Thailand • Anesthesiologist from Malaysia • Nurses from Indonesia and Philippines • Operating room in Cambodia

35. THANK YOU FOR YOUR KIND ATTENTION! email: jcuetomd@gmail.com