Document Type : Original Article(s)
Authors
1 Assistant Professor, Health Services Management, Hashemi Nezhad Hospital Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2 Professor, Health Services Management, Islamic Azad University, Research and Science Branch, Tehran, Iran
3 Assistant Professor, Health Services Management, Baghiat Allah University of Medical Sciences, Tehran, Iran
4 Health Services Management, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Introduction: Equitable access to a basic set of health services at minimum quality and affordable price is the right of every citizen and in all countries the governments have the duty to deliver these services to the population. International trade in health services influences the balance between equitable distribution of these services, creating incentives to improve the efficiency of health systems, and managing the limited financial resourcesof the governments. It also creates opportunities and challenges for health systems and communities. This paper reviewed different modes of trade in health services and investigated the opportunities and challenges resulted from this kind of trade in the selected countries of ASEAN region to make Iranian health policy makers and operators aware of trade in health sector.Methods: This paper was resulted from a section of an applied descriptive-comparative study about international trade in health services conducted during 2008-2010. Data was collected using digital and printed resources. The research population included 3 countries of ASEAN region, namely Malaysia, Singapore, and Thailand. The extracted information was used to generally picture the status of international trade in health services in the region and to compare the related opportunities and challenges.Results: International trade in health services in the studied countries involved 4 modes including supply as cross-border supply of the services, consumption abroad (health tourism), commercial presence (foreign direct investment), and temporary immigration of persons (health professionals). The trade provides opportunities for earning revenues and promoting the quality of available health services, but it also raises challenges in competing with other countries (of ASEAN) and in accessibility and affordability of health services for the country population.Conclusion: The most important challenges the ASEAN countries face in developing trade in health services include accelerating credit provision for service providers, portability of health insurance, developing and protecting the private sector, cooperation between the public and private sectors, and expanding the trade based on relative strengths of each country in order to improve the health sector.Keywords: International Trade; Health Services; Medical Tourism.
- Arunanondchai J, Fink C. Trade in health services in the ASEAN region. Health Promot Int 2006; 21(suppl 1): 59-66.
- Siddiqi S, Shennawy A, Mirza Z, Drager N, Sabri B. Assessing
- trade in health services in countries of the Eastern Mediterranean from a
- public health perspective. Int J Health Plann Manage 2010; 25(3): 231-50.
- Cattaneo O. Trade in Health Services What's in it for
- Developing Countries? The World Bank, Poverty Reduction and Economic
- Management Network, International Trade Department [Online]. 2009; Available
- from: URL: http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2009/11/05/000158349_20091105153652/Rendered/PDF/WPS5115.pdf/
- Dee P, Dihh H. Barriers to Trade in Health and Financial
- Services in ASEAN [Online]. 2009; Available from: URL: http://econpapers.repec.org/paper/erawpaper/d014.htm/
- Tullao TS, Cortez MA. Development of a private sector
- framework for ASEAN trade negotiations: Health care sector [Online]. 2006;
- Available from: URL: http://pdf.usaid.gov/pdf_docs/PNADJ692.pdf/
- Smith RD, Chanda PR, Tangcharoensathien V. Trade in
- health-related services. The Lancet 2009; 373(9663): 593-601.
- Cortez N. Patients without Borders: The Emerging Global
- Market for Patients and the Evolution of Modern Health Care. Indiana Law
- Journal 2008; 83(24). Availbale from: URL:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=982742/
- Lautier M. Export of health services from developing
- countries: the case of Tunisia. Soc Sci Med 2008; 67(1): 101-10.
- Bernal R. The Globalization of Health care Industry:
- Opportunities For the Caribbean. Cepal Review 2007; 92: 83-99.
- ESCAP. Medical Travel in Asia and Pacific; Challenges and
- Opportunities [Online]. 2007; Available from: URL: http://www.unescap.org/ESID/hds/lastestadd/MedicalTourismReport09.pdf/
- Joint Commission International (JCI). Accredited
- Organizations [Online]. 2008; Available from: URL: http://www.jointcommissioninternational.org/23218/iortiz/
- Smith R. Trade in Health Services: Current Challenges and
- Future Prospects of Globalization. In: Jones AM, Editor. The Elgar companion
- to health economics.London: Edward Elgar Publishing; 2006. p. 167.
- Blouin C, Gobrecht J, Lethbridge J, Singh D, Smith R, Warner
- D. Trade in Health Services under the Four Modes of Supply: Review of
- Current Trends and Policy issues. In: Blouin C, Drager N, Smith R, Editors.
- International trade in health services and the GATS: current issues and
- debates.Washington (DC): World Bank Publications; 2006. p. 203-8.
- Chanda R. Trade in Health Services. World Health
- Organization 2002; 80(2): 158.
- Heinzelmann P, Chau R, Liu D, Kvedar J. Cross Cultural
- Telemedicine Via Email: Experience in Cambodia and the USA. In: Wootton RW,
- Patil NG, Ho K, Editors. Telehealth in the Developing World.London: IDRC;
- p. 135-48.
- Wibulpolprasert S, Pachanee CA, Pitayarangsarit S, Hempisut
- P. International service trade and its implications for human resources for
- health: a case study of Thailand. Hum Resour Health 2004; 2(1): 10.
- Smith RD. Foreign direct investment and trade in health
- services: a review of the literature. Soc Sci Med 2004; 59(11): 2313-23.
- Mortensen J. International Trade in Health Services
- assessing the Trade and the Trade-Offs. DIIS Working Paper 2008; 2008(11):
- Widiatmoko D, Gani A. International Relations within
- Indonesia Hospital Sector. In: Drager N, Vieira C, Editors. Trade in health
- services: global, regional, and country perspectives.Texas: Pan American
- Health Organization, Program on Public Policy and Health, Division of Health
- and Human Development; 2002. p. 108-17.
- Chanda R. Foreign Investment in Hospitals in India: Status
- and Implications [Online]; 2007; Available from: URL: http://www.whoindia.org/LinkFiles/Trade_Agreement_FDI-1.pdf/
- Rahman M. Bangladesh- India Bilateral trade: an
- Investigation into Trade in Services [Online]. 2007; Available from: URL:
- http://www.eldis.org/assets/Docs/28871.html/
- Kumar P, Simi TB. Barriers to Movement of Health
- Professionals: A Case Study of India. CUST Center for International Trade,
- Economics and Environment [Online]. 2007; Available from: URL; http://www.whoindia.org/LinkFiles/Trade_Agreement_Barriers_to_Movement_of_Healthcare_Professionals.pdf/
- Representative Office in Malaysia. WHO Country Cooperation
- Strategy Malaysia 2006-2008 [Online]. 2009; Available from: URL: www.who.int/countryfocus/cooperation_strategy/ccs/
- Leng CH. Asia Research Institute Working Paper Series No.
- , Medical Tourism in Malaysia: International Movement of Healthcare
- Consumers and the Commodification of Healthcare [Online]. 2007; Available
- from: URL: http://www.ari.nus.edu.sg/docs/wps/wps07_083.pdf/
- Opportunity in Asian Medical Tourism (2007-2010) [Online].
- ; Available from: URL: http://www.rncos.com/Report/IM0102.htm/
- Khoo L. Trends in Foreign Patients admission in Singapore.
- MOH information Paper [Online]. 2003; Available from: URL;
- http://www.moh-uat.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2003/
- TRENDS_IN_FOREIGN_PATIENT_ADMISSION_IN_SINGAPORE.pdf/
- Lethbridge J. Strategies of Multinational Health Care
- Companies in Europe and Asia. In: Mackintosh M, Koivusalo M, Editors.
- Commercialization of health care: global and local dynamics and policy
- responses.Sydney: Palgrave Macmillan; 2005.
- Herrick D. Medical Tourism: Global Competition in Health
- Care. NCPA Policy Report [Online]. 2007; Available from: URL: http://www.ncpa.org/pub/st304/
- Sitthi-amorn C, Somrongthong R, Janjaroen WS. Some health
- implications of globalization in Thailand. Bull World Health Organ 2001;
- (9): 889-90.
- Janjaroen W. Supakankuntis. International trade in health
- Services in the Millennium: The Case of Thailand. In: Drager N, Vieira C,
- Editors. Trade in health services: global, regional, and country
- perspectives.Washington (DC): Pan American Health Organization, Program on
- Public Policy and Health, Division of Health and Human Development; 2002. p.
- -106.
- Mikic M. Health-related Services in Multilateral and
- Preferential Trade Arrangements in Asia and the Pacific [Online]. 2007;
- Available from: URL: http://econpapers.repec.org/paper/escwpaper/3007.htm/
- Davis L, Erixon F. The health of nations: Conceptualizing
- approaches to trade in health Care. ECIPE policy Briefs 2008; 4: 1-12.