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Health Beyond Borders: Healthcare Challenges in ASEAN and Issues Concerning Health Professionals

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Health Beyond Borders: Healthcare Challenges in ASEAN and Issues Concerning Health Professionals Dr Phua Kai Hong AB cum laude SM (Harv), PhD (LSE) – PowerPoint PPT presentation

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Title: Health Beyond Borders: Healthcare Challenges in ASEAN and Issues Concerning Health Professionals


1
Health Beyond Borders Healthcare Challenges in
ASEAN and Issues Concerning Health Professionals
Dr Phua Kai Hong AB cum laude SM (Harv), PhD
(LSE) National University of Singapore


2
Overview
  • Overview of ASEAN integration and its impact
  • - Trade in Health Services
  • - Rise of Medical Tourism and Health
    Industries
  • - Health of Migrants/Migrant Health Workers
  • Health Systems Development in ASEAN
  • - Universal Health Coverage
  • - Delivery, Financing, Regulation,
    Information
  • Prospects and Challenges in the Health Sector
  • - Demand and Supply Conditions   
  • - ASEAN Health Governance

3
Asia in Transition
  • Socio-economic
  • - Rapid industrialization/technological
    changes
  • - Rising affluence and consumption
  • - Increasing privatization and corporatization
  • Demographic
  • - Rural-urban migration and travel
  • - Fertility decline and family formation
  • - Increasing longevity and ageing
  • Epidemiological
  • - New and re-emerging infectious diseases
  • - Rise of chronic non-communicable diseases
  • - Double burden ? Triple burden of
    diseases

4
Lancet Series on Health in Southeast Asia
Overview on health and health-care, 2011
5
Improving Life Expectancies in South East Asia
6
Improving Health in Southeast Asia
7
Key Messages Health in S.E. Asia
  • The diversity of geography and history, including
    social, cultural, and economic differences have
    contributed to highly divergent health status and
    health systems across and within countries.
  • Demographic transition is taking place at among
    the fastest rates compared with other regions of
    the world, whether in terms of fertility
    reductions, population ageing, and rural to-urban
    migration. Rapid epidemiological transition is
    also occurring with the disease burden shifting
    from infectious to chronic diseases.
  • Rapid urbanisation, population migration and
    high-density living raise concerns about newly
    emerging infectious diseases, but the outbreaks
    have stimulated regional cooperation in
    information exchange and improvement in disease
    surveillance systems.
  • The peculiar geology contributes to it being the
    most disaster-prone region in the world, more
    susceptible to natural and man-made disasters
    affecting health, including earthquakes,
    typhoons, floods, and environmental pollution.
    Climate change along with rapid economic
    development could exacerbate the spread of
    emerging infectious diseases.

8
Key Messages - Health Systems in SE Asia
  • Regional health systems are a dynamic mix of
    public and private delivery
  • and financing, with new organisational forms such
    as corporatised public
  • hospitals, and innovative service delivery
    responding to competitive private
  • health-care markets and growing medical tourism.
  • The health-care systems are highly diverse,
    ranging from dominant
  • tax-based financing to social insurance and high
    out-of-pocket payments.
  • There is a greater push for universal coverage of
    the population, but more
  • needs to be done to ensure access to health
    services for the poor.
  • Private expenditure is increasing relative to
    government expenditure,
  • where new forms of financing include user
    charges, improved targeting of
  • subsidies and greater cost recovery. Health
    financing could be further
  • restructured in response to future demographic
    shifts in age-dependency,
  • as in medical savings and social insurance for
    long-term care.
  • There is potential for greater public-private
    participation with economic
  • growth through regional integration and
    international health collaboration,
  • despite the current division of the region under
    two WHO regional offices.

9
Comparative Health Systems in Asia
  • Public-Private / Modern-Traditional /
    Formal-Informal
  • Pluralistic systems in most countries
  • With Universal Coverage
  • Social Health Insurance (SHI)
  • - Japan, Korea, Taiwan, Thailand
  • Tax-based National Health Service (NHS)
  • - Hong Kong, Malaysia, Brunei, Sri Lanka
  • Singapore (with mixed public-private,
    cost-sharing system
  • and 3M schemes - Medisave/Medishield/Medif
    und)
  • Towards Universal Coverage
  • Social Health Insurance and Tax-based Public
    Healthcare
  • - Philippines, Indonesia and other emerging
    economies
  • Social Health Insurance
  • - China, Vietnam and transitional economies
  • What is the optimum financing system?

10
The Iron Triangle of Health Care
Universal Health Coverage
Quality (Effectiveness)
Cost/Affordability (Efficiency)








Access (Equity)
Means-testing
11
Comparative Health Systems Impact of Medical
Tourism Industry?
12
Comparative Health Studies in Asia and Europe
13
Comparative Health Systems Regional Governance
in EU vs ASEAN
Comparative Studies of Health and Migration
14
Stakeholder Analysis for Healthcare Systems
Whose Costs and Whose Values?
15
Future Global Health Policy Challenges Goals
for Research and Training
  • Produce information conduct policy research,
    collect, analyze and synthesize evidence
  • Communicate evidence dissemination or
    publication, media/PR, social marketing
  • Build capacity train health policy researchers,
    broker knowledge transfer and partnerships
  • Promote/advocate policy and action
  • - engage with stakeholders/policy-makers
  • - monitor take-up by policy-makers
  • - evaluate policy implementation

16
the Health and Social Policy Matrix (Whole of
Society Approach)
Policy Levels
Governance/Regulation/Provision/Financing
National/Societal
Local/Community
Individual/Family
Private/ Markets
Public / Government
People/ Civil Society
Sectors
17
Paradigm Shifts in Public Health Policy
Globalization
Democratization
Civil Society
Health Policy
Government
Business
Public-Private Participation
18
Towards Future Regional Collaboration From
Research to Policy to Action!
  • ASEAN Summit on SARS
  • Bangkok, April 29, 2003
  • ASEAN 3 Health Ministers
  • Meeting on Type A (H1N1) Flu Bangkok,
    May 8, 2009
  • ASEAN Health Ministers and Senior Officials
    Meeting
  • Singapore 2010, Phuket 2012, ???

What Next?
19
ASEAN Cooperation in Health
  • Modus Operandi
  • Technical Working Groups (TWG) ? Senior
    Officials Meeting (SOM) ?ASEAN Health Ministers
    Meeting (AHMM)
  • Turning Points
  • SARS 2003
  • ASEAN Charter 2007 ASCC Blueprint ASEAN
    Health Division established
  • Engagement in Health
  • Regional declarations and agreements on
    health
  • ASEAN within a Global Health Governance framework
  • Limited cooperation with WHO (structural
    divisions in SEARO/WPRO)
  • ASEAN partners, APEC, TPP and other
    regional blocs
  • Rising civil society and third sector

20
ASEAN 2015 Mutual Recognition Arrangement on
Medical Practitioners
  • RECOGNISING the objectives of the ASEAN Framework
    Agreement on Services (AFAT), which are to
    enhance cooperation in services .ASEAN Member
    States under the General Agreement on Trade in
    Services (GATS)..
  • RECOGNISING ASEAN Vision 2020 on Partnership in
    Dynamic Development, approved on 14 June 1997,
    which charted towards the year 2020 for ASEAN the
    creation of a stable, prosperous and competitive
    ASEAN Economic Region ...
  • NOTING the decision of the Bali Concord II
    adopted at the 9th ASEAN Summit held in 2003
    calling for the completion of Mutual Recognition
    Arrangements (MRA) for qualifications in major
    professional services by 2008 to facilitate free
    movement of professionals/skilled labour/talents
    in ASEAN and
  • PROVIDING an MRA for Medical Practitioners that
    would strengthen professional capabilities by
    promoting the flow of relevant information and
    exchange of expertise, experiences and best
    practices .....

21
ASEAN 2015 MRA (contd)
  • ARTICLE I OBJECTIVES
  • ARTICLE II DEFINITIONS
  • Professional Medical Regulatory Authority (PMRA)
    refers to a body vested with the authority by the
    government in each ASEAN Member State to regulate
    and control Medical Practitioners and their
    practice of medicine
  • ARTICLE III RECOGNITION AND ELIGIBILITY OF
    FOREIGN MEDICAL PRACTITIONERS
  • ARTICLE IV PROFESSIONAL MEDICAL REGULATORY
    AUTHORITY
  • ARTICLE V RIGHT TO REGULATE
  • ARTICLE VI ASEAN JOINT COORDINATING COMMITTEE
    ON MEDICAL PRACTITIONERS
  • ARTICLE VII MUTUAL EXEMPTION
  • ARTICLE VIII DISPUTE SETTLEMENT
  • ARTICLE IX AMENDMENTS
  • ARTICLE X FINAL PROVISIONS
  • Signed by Ministers of Trade and Industry of all
    ASEAN Member States

22
Beyond ASEAN Community 2015
  • Proposals to support healthcare integration
  • ASEAN wide framework for portability of health
    insurance and payment mechanisms
  • Minimize visa requirements for patients
  • Balance region-wide demand and supply of health
    care workers, materials, resources, etc
  • Harmonisation of professional standards
  • Region-wide quality standards for training,
    accreditation, licensing, monitoring, etc

23
Health Care Policy and Governance Challenges in
Asia Facing Diversity and Disparities!
24
Selected References
  • Nichols LM, Prescott N and Phua KH, Medical
    Savings Accounts for Developing Countries, in
    Innovations in Health Care Financing, GJ Schieber
    (ed), World Bank Discussion Paper No. 365, 1997
  • Phua KH, Medical Savings Accounts and Health Care
    Financing in Singapore, in Innovations in Health
    Care Financing, GJ Schieber (ed), World Bank
    Discussion Paper No. 365, 1997
  • Phua KH, Comparative Health Care Financing
    Systems, with Special Reference to East Asian
    Countries, Research in Healthcare Financial
    Management 5(1), 1999
  • Phua KH, Financing Health and Long Term Care for
    Ageing Populations in the Asia-Pacific Region,
    Ageing in the Asia-Pacific Region, Philips D
    (ed.) 93-112, Routledge, London, 2000
  • Phua KH, The Savings Approach to Financing Long
    Term Care in Singapore, Journal of Ageing and
    Social Policy 13(2/3) 169-183, 2001
  • Phua KH, Towards a Comparative Analysis of Health
    Systems Reforms in the Asia-Pacific Region,
    Asia-Pacific Journal of Public Health 14(1)
    9-16, 2002
  • Phua KH, Health Care Financing in the
    Asia-Pacific Region, Public Administration and
    Policy11(2)13-36, 2003
  • Phua KH, Attacking Hospital Reforms on Two
    Fronts Network Corporatization and Health Care
    Financing, Innovations in the Delivery of Health
    Services, Preker A Harding A (eds), Human
    Development Network, World Bank, 2003
  • Phua KH, Singapore, Chapter in Social Health
    Insurance Selected Case Studies from Asia and
    the Pacific, WHO WPRO and SEARO, March 2005

25
Selected References
  • Virasakdi C, Phua KH, Yap MT et al, Health and
    Health-care Systems in Southeast Asia
    Diversities and Transitions, Lancet, January 2011
  • Phua KH and Pocock N, Medical Tourism and
    Implications for Health Systems Globalization and
    Health, 712, 2011.
  • Lamy, Marie and Phua, Kai Hong (2012) Regional
    health governance a comparative perspective on
    EU and ASEAN, EU Centre Policy Brief 4, June
    2012
  • Lamy M and Phua KH, Southeast Asian cooperation
    in health a comparative perspective on regional
    health governance in ASEAN and the EU,
    Asia-Europe Journal, 10(4) Aug 2012
  • Trummer U, Novak-Zezula S, Phua KH et al,
    Migrants and Healthcare Social and Economic
    Approaches, Asia-Europe Foundation, 2014
  • Phua KH and Wong MLL, Comparative Health Systems
    in Asia, in Routledge Handbook of Global Public
    Health in Asia , Griffiths S at al (eds),
    Routledge, 2014
  • Smullen A and Phua KH, Comparative Analysis of
    Health Systems in Asian High-Performing
    Economies, Policy Brief, Journal of Asia
    Pacific Policy Studies, Australian National
    University, 2015
  • Phua KH et al, Public Health and Development in
    Middle Income Countries, The Oxford Textbook of
    Global Public Health (5th edn), Oxford University
    Press, 2015
  • Phua KH, Health and Health Systems in Southeast
    Asia, World Scientific, 2015 (forthcoming)
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