I was inspired by both Dr Yodi Mahendradhata’s lectures; 1. Globalization of Trade in Health Services and Workforce 2. Global Health and Decentralization. He gave us a clear view of what is happening to our health system around the globe, improvement of health sector, problems that occur due to these improvements, ways to overcome the problems, together with sufficient information and statistics as an example.
One of the phenomenons in health system right now is the international trades in health services, which can be divided into four categories;
1. Cross border trade
"the buying and selling of goods and services between two countries"
In the year of 2005, the most popular cross border revenues are customer interaction center, medical transcription and financial/accounting services.
2. Consumption abroad
"the freedom for the citizens of one country's to purchase services in the territory of another country."
Countries in Southeast Asia have interests in developing different kinds of surgeries based on available specialist and equipments in each country. For example, Singapore is well known for their cardiac and neurosurgery, joint replacements and liver transplants, Malaysia is famous for its cardiac and cosmetic surgery while Thailand can be recognized by its cosmetic and sex exchange surgery. The origin of patients for each country also differs, but sometimes overlapping as for example, Indonesia’s patients ranked number one as the origin of patients in both Malaysia and Singapore.
3. Commercial presence
"the opportunities for foreign service suppliers to establish, operate or expand a commercial presence in the other country, such as a branch, agency, or wholly-owned subsidiary."
4. Natural presence
"the possibilities offered for the entry and temporary stay in the country of foreign individuals in order to supply a service."
What are the problems then?
Globalization in health causes imbalanced in global distribution of health workforce, due to shortage of doctors in certain regions (e.g. Africa and Southeast Asia), in sense that there are outflow of health workers (doctors, nurses, midwives) from especially developing countries to the more developed countries.
Reasons for brain drain
- Better remuneration
- more favorable working environment
- Location of facilities in towns and cities
- Bureaucracy in own country
- Heavy workload in own country
As I mentioned in the previous posts, besides the migration to other countries, doctors especially prefer to work in urban rather than rural area. Thus, these are some policy options that can be taken into consideration by the government:
- In case there are a lot of commercial presences inside one’s country (which is usually private hospitals), publicly employed specialists mandated to work specific number of hours in public sector before treating private patients.
- pro poor financing mechanism in place. (e.g. private hospitals mandated to provide certain percentage of services to poor patients)
- in case of often consumption abroad, imply tax on medical tourist revenues.
