Healthcare Healthcare Professionals: IssuesProfessionals: Issues

Jose Y. Cueto Jr., MD, FPCS, FPSGS, MHPEdDean

MMSU College of Medicine

Health Beyond BordersHealthcare Challenges in ASEAN and Issues Concerning Health

ProfessionalsSt. Lukes Medical Center

August 24, 2015

Single Market and Production

Base

Competitive Economic

Region

EquitableEconomic

Development

Integration into the Global Economy

ASEAN ECONOMIC COMMUNITY

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

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

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

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

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

4. In compliance with CPD requirements5. 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

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 CommissionProfessional Regulatory Board of Medicine

Singapore Singapore Medical Council Specialists Accreditation Board

Thailand Thailand Medical CouncilMinistry of Public Health

Vietnam Ministry of Health

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

COUNTRY A COUNTRY BMode 1: Cross border supply

Mode 2: Consumption abroad

Mode 3: Commercial presence

Consumer A

The service crosses the border

Service

supply

Service Supplier

Service Supplier

Consumer A

Consumer A

Consumer A

Service Supplier

Commercial

Presence

Establishes a commercial presence in AService

supply

Mode 4: Movement of natural persons

Employee sent by firm from B

Naturalperson

Self-employed goes to Member A

COUNTRY A COUNTRY B

Naturalperson

Consumer A

Consumer A

Commercial

Presence Juridical person

Service

supply

Service

supply

1. Variation in qualification requirements across borders

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

COUNTRYCOUNTRY NO. OF NO. OF YEARSYEARS

DIPLOMA/DEGREE DIPLOMA/DEGREE

Brunei Brunei DarussalamDarussalam

3 years3 years

4 years4 yearsDiploma in Health Science (Nursing)Bachelor of Health Science (Nursing)

CambodiaCambodia 3 years 4 years

Associate Degree in NursingBachelor Science Nursing

Lao PDRLao PDR 3 years3 years

2.5 years2.5 years

4 years4 years

Diploma in Nursing Continuing Bachelor in Nursing Science (Upgrade from diploma)

Bachelor Science in Nursing

IndonesiaIndonesia 3 years4 years

Diploma in Nursing Diploma in Nursing Bachelor in Nursing

MalaysiaMalaysia 3 years4 years

Diploma in Nursing Bachelor Science in Nursing

COUNTRYCOUNTRY

NO. OF NO. OF YEARSYEARS

DIPLOMA/DEGREE DIPLOMA/DEGREE

MyanmarMyanmar 3 years3 years

4 years4 yearsDiploma in Nursing Bachelor of Nursing Science

PhilippinesPhilippines 4 years4 years Bachelor of Science in Nursing Bachelor of Science in Nursing (BSN)(BSN)

ThailandThailand 2 years2 years

4 years 4 years BSN for Associate Diploma Nurses BSN for Associate Diploma Nurses

Bachelor of Science in Nursing Bachelor of Science in Nursing (BSN)(BSN)

SingaporeSingapore 3 years3 years

12 months12 months

3 years/4 3 years/4 yearsyears

Diploma in Nursing Diploma in Nursing

Bachelor of Science Conversion Bachelor of Science Conversion Program for RNsProgram for RNsBachelor of Science (Nursing)/(Hounors)

VietnamVietnam 2 years full 2 years full timetime

3 years full 3 years full timetime

4 years full 4 years full timetime

4 years part 4 years part time time

Certificate NurseCertificate Nurse

Junior BsN (College of Nurse)Junior BsN (College of Nurse)

Senior, BsN (Bachelor of Nursing Senior, BsN (Bachelor of Nursing Science)Science)

Bachelor of NursingBachelor of Nursing

Comparability of ASEAN Nursing programs (Basic Nursing Education)

1. Variation in qualification requirements across borders2. Differences in religion and culture

RELIGION COUNTRY / COUNTRIES

Buddhist Cambodia Lao PDR Myanmar Thailand Vietnam

Muslim Brunei Indonesia Malaysia

Catholic (predominant)

Philippines

Diverse Singapore

1. Variation in qualification requirements across borders2. Differences in religion and culture3. Differences in language and difficulty in communication

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

1. Variation in qualification requirements across borders2. Differences in religion and culture3. Differences in language and difficulty in communication4. Mismatch in available and needed health professional

Quantity Quality Distribution

Surpluses? Shortages? Actual needs?

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

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

1. Variation in qualification requirements across borders2. Differences in religion and culture3. Differences in language and difficulty in communication4. Mismatch between available and needed health professional5. Adjustment to local rules/regulations6. Acceptance by local practitioners

HEALTHCARE PROFESSIONALS

CHALLENGES

1.Qualifications2.Religion3.Culture

4.Language5.Mismatch 6.Local rules7.Acceptance

HOST COUNTRIES

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

ASEANMedical

Practitioners

PMRA

QualificationRecognition

Process

PMRA

ConferTemporary

RegistrationLicensing

LimitedPractice

ExpertVisit

EducationTraining

Research

HumanitarianMissions

Dissemination

Engagement

Professional RegulatoryAuthorities

Professionals /Professional

Organizations

Educational and Healthcare Institutions

ASEAN Integration

Regional Standards

Basic Qualification

Postgraduate Qualification

Professional Practice

ContinuingProfessional Development

ASEAN Integration

ASEAN MRA: Mobility

ComparabilityStudies

Identification ofChallenges

Labor Market Conditions

Engagement ofStakeholders

Surgeons from Cambodia and Thailand

Anesthesiologist from Malaysia

Nurses from Indonesia and Philippines

Operating room in Cambodia

THANK YOU FOR YOUR KIND ATTENTION!

email: jcuetomd@gmail.com