Jose Y. Cueto Jr., MD, FPCS, MHPEd Philippine Representative to the ASEAN Joint Coordinating Committee for Medical Practitioners (AJCCM), ASEAN MRA Member, Professional Regulatory Board of Medicine, PRC Overall Coordinator, Working Group for International Alignment, Philippine Qualifications Framework (PQF), PRC Member, Task Force for the ASEAN Qualifications Reference Framework (AQRF) Masters in Health Professions Education, UP National Teachers Training Center for Health Professions, UP Manila Residency Training in General Surgery UP – Philippine General Hospital Doctor in Medicine UP College of Medicine
Transcript
Jose Y. Cueto Jr., MD, FPCS, MHPEd
Philippine Representative to the ASEAN Joint Coordinating Committee for
Medical Practitioners (AJCCM), ASEAN MRA
Member, Professional Regulatory Board of Medicine, PRC
Overall Coordinator, Working Group for International Alignment,
Philippine Qualifications Framework (PQF), PRC
Member, Task Force for the ASEAN Qualifications Reference Framework
(AQRF)
Masters in Health Professions Education, UP National Teachers Training Center
for Health Professions, UP Manila
Residency Training in General Surgery
UP – Philippine General Hospital
Doctor in Medicine
UP College of Medicine
Is the Healthcare Sector Ready
for ASEAN 2015?
Jose Y. Cueto Jr., MD, FPCS, MHPEd
Professional Regulatory Board of Medicine
Representative to the AJCCM
Overall Coordinator, PQF, PRC
17th Midyear Convention of the Philippine College of Chest Physicians
August 6, 2014
ASEAN MRA: what
do we need to
know?
ASEAN Integration
2015: what are the
components?
What will be the
challenges in the
healthcare sector?
Reference to SUBSTANCE of integration
Complete Economic Integration
Economic & Monetary Union
Common Market
Customs Union
Free Trade Areas
Conceptual Framework
RECOGNITION DEVELOPMENT HARMONIZATION
OF QUALIFICATIONS
MOBILITY OF PROFESSIONALS
(ASEAN ECONOMIC COMMUNITY 2015)
MRA PQF AQRF
ASEAN MRA: Most important
issues
What is the basis for the agreement?
What are the eligibility requirements to
move to other countries?
What are the modes of supply of services?
What will be the ultimate form of mobility?
ASEAN Framework Agreement on
Services (AFAS)Article V : Recognition
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.
The ASEAN Mutual Recognition
Arrangements
PROFESSIONAL SERVICES DATE OF SIGNING
1. ENGINEERING Dec. 2005
2. NURSING Dec. 2006
3. SURVEYING Nov. 2007
4. ARCHITECTURE Nov. 2007
5. DENTISTRY Aug. 2008
6. MEDICINE Feb. 2009
7. ACCOUNTANCY Feb. 2009
Recognition and Eligibility of Foreign
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 practicing certificate to practice
issued by PRA of country of origin
3. Has been in active practice in country of origin
Engineering/Architecture: 7 years
Medicine/Dentistry: 5 years
Nursing: 3 years
Recognition and Eligibility of Foreign
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
ASEAN MRA: Recognition
RECOGNITION
OF
QUALIFICATIONS
BY
HOST COUNTRY
PROFESSIONALS
1. In possession of
qualification
2. Valid registration and
license
3. Work experience
4. In compliance with CPD
requirements
5. Certification of not
having violated any
professional or ethical
standards
6. No pending
administrative or legal
proceeding
ASEAN MUTUAL RECOGNITION
ARRANGEMENTS
Right to Regulate - These MRAs shall not
reduce, eliminate or modify the rights,
power and authority of each ASEAN
Member State, its Professional Regulatory
Authority and other relevant authorities to
regulate and control practitioners and the
practice of profession.
1• Cross-Border Supply
2• Consumption Abroad
3• Commercial Presence
4• Movement of Natural Persons
V. Services, unlike goods, have 4 modes of supply
MEMBER A MEMBER B
Mode 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
Modes of Supply
Mode 4: Movement of natural persons
Naturalperson
Self-employed goes to Member A
MEMBER A MEMBER B
Naturalperson
Consumer A
Consumer A
Commercial Presence
Juridical person
Service
supply
Service
supply
Modes of Supply
Mode 1: Cross Border Supply
Cambodia
Philippine
Hospital
Singapore
Hospital
Mode 1: Cross border supply
Mode 2: Consumption Abroad
Philippines
Singapore
Mode 3: Commercial Presence
Thailand
Mode 4: Movement of natural
persons
Implications for Practice
Mode 1: Cross border supply
Technology-based
Diagnostic radiology
Histopathology
Medical transcription
Medical research
Education: distance learning mode
Implications for Practice
Mode 2: Consumption abroad
(Medical Tourism)
Services offered/Value-added
Diagnostics
Surgical procedures
Minimally invasive procedures
Medical education
Thai students
Residency training/Subspecialty
Indonesia, Nepal, India, Pakistan
Implications for Practice
Mode 3: Commercial presence
Foreign companies invest in the
Philippines
Build tertiary hospitals and diagnostic
centers
May bring their own people with them
Mode: competing or cooperating?
Joint ventures / cooperative undertakings
Implications for Practice
Mode 4: Movement of natural persons
Full/Free mobility: countries with similar education, accreditation, certification systems, and professional practice
US and Canada
Australia and New Zealand
10 ASEAN countries: wide variation
Limited Practice
Temporary registration
Form of Mobility
Temporary Licensing/Registration in the ff:
1. Limited Practice
2. Expert Visit
3. Education / Training
4. Research
5. Humanitarian Missions
No need for licensure examinations
Trade in Services
Temporary
Short term
Does not involve:
Permanent registration
Acquisition of citizenship
Permanent employment
Differences in Form of Mobility
Engineering
Architecture
Accountancy
*ASEAN Registry
Dentistry
Medicine
Nursing
Options
ASEAN HEALTHCARE
PROFESSIONALS
COMPETE COMPLEMENT
COUNTRY
Number of
Accredited
Hospitals
First Hospital to Attain Accreditation /
Date attained
1. Thailand 18 Bumrungrad International: 2 Feb 2002
2. Philippines 5 St. Lukes Medical Center: 22 Nov 2003
3. Singapore 14 National University Hosp: 1 Aug 2004
4. Indonesia 5 Siloam Hospital Lippo Village: 19 Sept 2007
5. Malaysia 7 Penang Adventist Hospital: 16 Nov 2007
COUNTRY
Number of
Accredited
Hospitals
International Business and Trade
(In US dollars)
1. Thailand 18 1.3B
2. Singapore 14 750M
3. Malaysia 7
4. Indonesia 5
5. Philippines 5 250M
Cooperative Ventures to Achieve
Economic Pillars
ASEAN Cooperative Frameworks on Investments and Services
a. ASEAN Industrial Cooperation Scheme (AICO)
b. ASEAN Framework Agreement on Services (AFAS)
c. ASEAN Agreement on Movement of Natural Persons (AAMNP)
d. ASEAN Comprehensive Investment Agreement (ACIA)
Potential Cooperative ASEAN
Ventures under ACIA1. Food production
2. Energy
3. Oil production/development
4. Deuterium fuel production
5. ASEAN shipping and cruise lines
6. ASEAN railways
7. ASEAN air transport
8. Capital intensive projects
9. Space mission projects (for weather)
Potential Cooperative ASEAN
Ventures under ACIA
10. Tourism projects
11. Tertiary hospitals
12. SME support facilities
13. ASEAN industrial estates
14. Agribusiness
15. Insurance
16. ASEAN stocks
17. Research and training centers
18. ASEAN or Thai Canal
ASEAN Ventures
Free Flow of Investments
Building of Tertiary Hospitals, Research and Training Centers by foreign multinational companies
(Mode 3: Commercial presence)
Bringing of CEO’s / intracorporate transfers of key personnel (Mode 4: Movement of natural persons)
Future Healthcare Institutions
Operating Room Setting:
TEAM COMPOSITION: Multinational
Singaporean Surgeon
Thai Anesthesiologist
Indonesian Surgical Resident (Assist)
Filipino / Cambodian Nurses
Competition
1. Professionals: at level of Specialists
2. Investments
OPTIONS
COMPETE COMPLEMENT
SPECIALIZATION:
Most Important Issues
1. What is the present situation?
2. Which body regulates residency training? In the
ASEAN MRA, which is/are the PMRA?
3. Which body confers recognition of specialty
societies and specialty boards?
Recognition to training institutions? Recognition
of certificates as Diplomates and Fellows?
4. How will the present situation affect
competitiveness of specialists?
Issue No. 1
1. What is the nature of residency training
and specialization?
Issue No. 2
2. Which body regulates residency training?
In the ASEAN MRA, which is/are the
Professional Medical Regulatory
Authority?
ASEAN MRA
Article II. 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”
PMRA’s: ASEAN Countries
COUNTRY Professional Medical Regulatory Authority
1. Brunei Darussalam Brunei Medical Board
2. Cambodia Cambodian Medical Council and Ministry of Health
3. Indonesia Indonesian Medical Council and Ministry of Health
4. Lao PDR Ministry of Health
5. Malaysia Malaysian Medical Council
6. Myanmar Myanmar Medical Council and Ministry of Health
7. Philippines Professional Regulation Commission
Professional Regulatory Board of Medicine
8. Singapore Singapore Medical Council
Specialists Accreditation Board
9. Thailand Thailand Medical Council and Ministry of Public
Health
10. Vietnam Ministry of Health
Recognition
ASEAN MRA requirements (2010)
Submission of:
1. Basic Qualifications and List of
recognized institutions
2. Postgraduate Qualifications and List of
recognized institutions
3. Core competencies and scope of
practice
Step 1. Situational Analysis
Undergraduate Medical
Education
Medical Schools: 38
Graduates: 4500
Takers PLE: 4000
Passers PLE: 2500
Passing: 62.9%
Poorly performing
medical schools: 17/38
Regulatory body: CHED
Postgraduate Medical
Education
Training Institutions
Graduates
Takers Certifying Exam
Passers
Passing
Poorly performing training
institutions
Regulatory Body: None
Specialties
Number of training programs
Passing percentage in
certifying examinations
General Surgery: 68 47.8%
Internal Medicine: 94 55%
Obstetrics-Gynecology: 93 60%
Pediatrics: 103 67%
Family Medicine: 46 53%
Pathology 44 40.70%
Needs of Professionals
PAFP Fellow
Applied for registration with Irish Medical Council (IMC)
IMC inquired from PRC whether the PAFP is a government-authorized body to conduct residency training in Family Medicine
Specialty certificate came from a private organization
ASEAN MRA Meeting
President of the Thailand Medical Council
Query: “why is it that Filipino specialists going to other countries carry with them certificates from private organizations only, and nothing coming from a government regulatory body”
9 other ASEAN countries: Medical Board, Medical Council, Ministry of Health
Singapore: Specialists Accreditation Board
Major Needs
1. To comply with requirements of an international agreement (ASEAN MRA)
2. To identify the regulatory body for postgraduate medical education (specialization)
3. To confer government recognition to training providers / institutions
4. To confer government recognition to specialists
5. To comply with the requirements of Executive Order No. 83 (PQF)
SONA
2011His Excellency Benigno S. Aquino III,
President of the Republic of the
Philippines, signed the
Executive Order No. 83 dated
October 1, 2012
INSTITUTIONALIZATION
OF THE
PHILIPPINE
QUALIFICATIONS
FRAMEWORK
Key Objectives
1. Establishes national standards and
levels for outcomes of education and
training, specializations, skills and
competencies
2. Provides national regulatory and quality
assurance arrangements for education
and training
IRR Rule II. Coverage
5.1 All sectors, levels, and modes of delivery of the Philippines’ trifocalized education system: basic education, technical vocational education and training, and higher education
5.2 All institutions and systems which provide trainings, specializations, skills and competencies, professional experience or through lifelong learning
