Beruflich Dokumente
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Freedom. The idea of freedom has been in the hearts and minds of
people and of countries for the duration of several years. Countries have
fought for this through literary works and others, through blood shed. Many
lives have been lost and many dreams have been shattered just to make the
idea of freedom turn into reality. Freedom can be personal. It could also be
economic or political. Although these have several definitions from different
sources, simply they are the freedom to exercise rights as citizens and rights
as a producer or a consumer in a globally competitive market. Countries in
the Southeast Asia region have struggled over the years for freedom. Their
diverse socioeconomic status, colonial history, political systems, health
systems, and health situation have been the barriers in achieving and
attaining freedom. The Southeast Asia region does not wish for more lives
lost. They have had enough over the years. They seek for freedom not
through swords and guns but through dialogue. By achieving peace, they
achieve freedom. They achieve personal, economic, and political freedom.
Southeast Asia is considered one of the most dynamic regions on earth
because of its great diversity among countries. These countries vary in size,
levels of development, resources both natural and human, histories, cultures,
languages, religions, races, politics and governance, economic and social
institutions, and values and traditions. The desire of these countries toward
economic growth, social progress and cultural development alongside peace
and stability paved the way for the establishment of the Association of
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This case was written by Maristella Divinagracia under the supervision of Dr. Kenneth Hartigan-Go, Asian
Institute of Management. All case materials are prepared solely for the purpose of class discussion. They
are neither designed nor intended to illustrate the correct or incorrect management of problems or issues
contained in the case.
Copyright 2012, Asian Institute of Management, Makati City, Philippines, http://www.aim.edu. No part of
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The average adult literacy rate for the six original ASEAN
members rose from 64 in 1970 to 83 in 1990, higher
than the world average and much better than the
average for the developing countries. 1
Indeed, such facts leave an impressive mark for the association. This
goes to show that the ASEAN, although it had a shaky take- off, its smooth
flight at present may attain its targeted goals and objectives after all.Or will
it? In a way, personal freedom has been achieved because people have the
right to live; to actually live long.
In spite the whopping record of the ASEAN, myriad of people have also
questioned the nature of it. There may be too much freedom among member
states because there are no governing body and set of rules for the ASEAN.
According to Rodolfo Severino, Jr, the Secretary General of ASEAN (19982002), the loose nature of the association, its informal style, and subtlety of
its processes have led many who write and speak superficially about ASEAN
to disparage it as a mere social club or talk- shop .To begin with, it does
not and it is not meant to have a supranational entity acting independently of
its members. In addition, it has no regional parliament, council of ministers,
law-making body, and no judicial system.With nothing holding all these
member states together, the member states seem to be hanging on a loose
thread. On the other hand, the ASEAN believes that there is nothing wrong in
being judged in that matter. Its member states believe that peace talk is the
best solution in arriving at solutions to quarrels. Cooperation is being called
to solve problems in order to generate understanding, agreement, and
friendship. Through friendship, enough investment is made to preserve peace
within the region. For them, this is enough to say that such club already has
a value. Looking at another perspective, relying on a friendly relationship
can work in the long run if people are living in an ideal world where everyone
is giving or sharing to others out of generosity and selflessness. People have
to remember that the world is in constant competition. Each country would
want to take the advantage of opportunities, goods, services, skilled labor
and everything else out in the market. As Paul Krugman stated in his
November/ December 1994 Foreign Affairs The Myth of Asias Miracle, he
did not doubt that East Asia would continue to grow at impressive rates; he
only expected that growth to slow down.
Amidst all this, the diversity of the ASEAN did not stop its
enlargement, rather it calls for a greater demand to keep ASEAN solidified
and strengthened. The member countries continue to aspire for freedom.
However, each member has increased eagerness to speak more freely to one
Severino, Rodolfo C. What ASEAN is and What it stands for. Asia Policy
Lecture. The Research Institute for Asia and the Pacific University of Sydney,
Australia. 22 October 1998.
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another. Ironically, such openness still has boundaries. The countries do not
hold the license to interfere with anothers internal affairs. This noninterference is the backbone of the ASEAN and it is that which makes it
unique. Dialogue among member states became more intensive and
interactions became more frequent. These conversations are held with
utmost caution and are put on a pedestal to cultivate cohesion rather than
cause more disputes.
ASEAN continues to strive to achieve its goals through the ASEAN
Economic Community (AEC) of having a single market and production base, a
competitive economic region, an equitable economic development, and
integration into the global economy. Indeed, economic freedom to promote
economic growth. ASEAN continues to characterize itself as a regional
association of free flowing goods, services, investment, skilled labor, and
capital. In addition, it is characterized by sound competition policy, consumer
protection,
intellectual
property
rights
protection,
infrastructure
development, competition in energy and mining, rationalized taxation, ecommerce and by small-medium enterprise (SME) development. Finally, it
continues to envision ASEANs centrality and participation in global networks.
All these should allow the association to benefit from efficiency while
boosting competitiveness. Also, it could strengthen institutions that will pave
the way for the regions socioeconomic development. ASEAN aims to
complete the AEC by 2015.
MUTUAL RECOGNITION ARRANGEMENT
Economic freedom is defined as the freedom of individuals to
specialize, exchange goods and services, compete in markets, and enjoy the
outcome they invested in2Economic freedom has pushed the ASEAN member
countries to facilitate the completion of AEC by 2015 and in line with the
ASEAN Framework Agreement on Services (AFAS), other terms of agreement
have been produced. A Mutual Recognition Arrangement (MRA) has been
proposed by the member countries to facilitate the free movement and
employment of qualified and certified professionals, particularly which of the
health care team members among the ASEAN countries. Led by the ASEAN
Tourism Task Force on Manpower Development and chaired by Indonesia,
this is achieved by reducing regulatory impediments to the movement of
goods, services, and in this case, of people.
The Healthcare sector is one of the twelve priority sectors that the
ASEAN leaders have identified for integration and creation of the AEC. This
Gwartney, James and Robert Lawson. Economic Freedom of the
World 2007 Annual Report, Philippine., ed. Lindsey Thomas Martin
(Fraser Institute, 2007), 7-37.
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prove its success. Suggestions have been made to make such harmonization
more applicable. First, ASEAN should adopt international standards in order
for ASEAN to expand their competition to the world market. Second, there is
a need to increase and expand public awareness to awaken the
consciousness of the industry, media, and public regarding the benefits of the
Roadmap to gather the support to hasten its implementation. Third, there is
a need to build capacity in regulatory authorities. Training and capacity
building should be held or coordinated at the ASEAN level and could include
exchange programs between ASEAN Member Country regulatory authorities.
Such cross visits would not only build trust and capacity among the regions
competent authorities, but would also create peer pressure for Member
Countries to improve their regulatory. 2Ironically again, for the ASEAN
Healthcare sector to become truly integrated, there is a call for liberalization
of healthcare services with limitation in respect to the nature of the
association in order to protect national interests.
People should keep in mind that the MRA shall not reduce,
eliminate, or modify the rights, power and authority of each ASEAN Member
State, its PMRA and other relevant authorities to regulate and control medical
practitioners and the practice of medicine. 5The question of preparedness of
each member country is being imposed given that the bottom line of having
to work in another country is due to the unequal distribution of health
workers causing the rural areas of the country to be understaffed. Even if
myriad of medical schools and trainings in both public and private facilities
are being set up in a country, the local employment opportunities are not
available to cater its production.
Population
(Millions)
Number
Doctors
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The figure shows the deviation of medical doctors from the red line of
equality. The blue line represents the distribution of medical doctors while
the green line represents the distribution of nurses. The greater deviation of
the Lorenz curve from the red diagonal line shows a higher degree of
inequality which is also represented as a higher Gini coefficient indicated
within the parenthesis. Cambodia shows the greatest degree of inequality
followed by Thailand. Even if Thailand faces inequality at sub-national level,
this country still attracts many foreign patients for health services. This
situation has resulted to the brain- drain within the country where medical
doctors from the public areas move and work to private hospitals. In a
country poor in resources, there is difficulty in the production of more
doctors. Heavy reliance on medical doctors can increase the inequality of
distribution in the sub-national level. 5
By 2015, the medical doctors of the ASEAN will face a borderless
practice as dictated by the ASEAN harmonization. A freedom that presents
itself as a double- edged sword. Outmigration of health professionals will be
further enhanced. To certain individuals, myriad of opportunities abroad
await them. For some, it is the question of the impact of MRA to the health
systems of country members.
Health and health- care systems in ASEAN
ASEAN is a region presently facing public health challenges. Social,
political, and economic developments over the years have provided health
gains in some countries and minimal effects on some. Given the location of
the member countries, earthquakes, tsunamis, typhoons, and other natural
disasters pose a threat to the people. Public policies have social and
economic consequences that cannot be ignored.
The MRA on medical doctors addresses regional cooperation and is a
good public health strategy. These medical doctors, coming from different
countries in the ASEAN, can treat disease outbreaks, chronic disease
epidemics, communicable, and non- communicable diseases. 7
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may be true for an ethnic group may not be applicable to a certain individual.
A medical doctor in a foreign land must understand the patients cultural
perspective. There is a call to respect and accept the patients way of life. On
the other hand, even if a medical doctor may have the knowledge about the
culture, there are still hindrances present. Ethnocentrism or the tendency of
man to think that their ways of behaving are right and that odd behaviors are
wrong and stereotyping can prevent appreciation for such cultural
differences.
As medical doctors practice their profession in a foreign land, they
gradually accept the new culture through a learning process. They accept
their own beliefs as well as the culture of the host country. Acculturation
occurs because the new member in the community must learn enough of the
new culture to survive. Although this could be seen as a positive effect, the
threat of cultural assimilation may occur. This is another challenge faced by
the medical doctor as he begins to gain a deeper knowledge on the scientific,
spiritual, or holistic health belief of his patient. This is indeed an undertaking
given that various countries in the West have colonized the countries in the
ASEAN. Singapore and Malaysia were colonized by Britain. Indo- china was
colonized by France while Philippines was colonized by the North Americans.
Parts of Indonesia have been under the Dutch and Germans.
Medical practitioners among ASEAN countries must make cultural
considerations. As mentioned, although the ASEAN countries are part of the
Asian/ Pacific Islanders, differences in religion and historical background may
cause the plan of treatment and approach to patients more individualized. As
an example, Philippines has been colonized by Spain and therefore has
additional or mixed beliefs and traditions with Asian/ Pacific Islanders.
COMPETENCY STANDARDS
There is competitiveness in terms of people as the region focuses on
building a global marketplace. This should mean that people are to be trained
through the acquisition of good education while upholding a healthy lifestyle.
Human resources and their capacity to produce are factors for economic
competitiveness especially in this day of age where everything becomes
knowledge-based and technologically advanced. Health then becomes an
important factor in the market although its relevance may differ for every
individual. People are consumers of healthcare services that constitute a
market. As consumers, they have varying purchasing powers. The question
now is the availability and accessibility of these goods and services.
People are consumers of healthcare services but their value as a
consumer differs from the time and the given circumstances. A consumer
functions poorly when one is ill. He may search for the best healthcare center
available or he may opt for a center that fits his budget. He may opt to go to
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Key Findings
There are more female than male
medical students in 68% of the
schools, but proportionately more
male students in 16% of the schools.
The gender distribution is variable in
the remaining schools.
Amin, Zubair, Khoo Hoon Eng, et al. Medical education in Southeast Asia:
emerging issues, challenges and opportunities. Medical Education (2005)
39:8. Web. 14 May 2012.
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Integrated Curricula
Clinical Training
Faculty Development
Student Assessment
Curriculum Governance
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Valuing Teaching
Curriculum Renewal
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countries because unlike the EU, there is no governing body in the ASEAN
that could implement laws. There is no supranational ASEAN government
that could dictate what should be done to achieve a standardized curriculum
for all medical schools in the ASEAN.
If the ASEAN continues to aspire for deeper integration, as evidenced
in the MRA, there is a need to establish stronger institutional structure that
has the right to enforce rules and regulation. The creation of the ASEAN
Secretariat in 1976 functions closely to that of an executive body that had no
authority to resolves arguments among the member countries. In addition,
the ASEAN Secretariat cannot authorize the final say in ASEAN agreements.
The position of a Secretary- General was created in 1992 and was given the
authority to initiate, advice, coordinate, and implement ASEAN activities. His
authority became questionable given that the ASEAN itself has no solid
regional identity. The Secretary- General cannot function at its fullest
because member states have no legally binding commitments to the ASEAN
itself.
If the MRA aims to have a standard on the education and professional
skills needed to be considered competent enough to work in another ASEAN
country, a deeper integration among member states with the call of a
supranational governing body is needed. The Council discusses different
issues with the ministers of the member states. It is the lack of decisionmaking power body that serves as a fatal weakness to the ASEAN
integration. Also, the ASEAN Charter has no recourse for the ASEAN
Secretariat should a member government be unable or unwilling to
implement agreements; that is, it lacks a supranational decision-making or
law-making organ for legislating community law, or for enforcing any ASEAN
protocols or resolution of disputes.9The system of the ASEAN itself makes
MRA challenging because there is no body that could dictate standard
measures that should be taken by the ASEAN members to create a win-win
situation for both the host country of the medical doctor and his country of
origin. In an ideal scenario, the age group, education, system of medical
schools, residency training exposure, licensure examination, board
certification for specialists, and earning range of doctors of all ASEAN
member countries are the same.
The absence of a supranational institution has caused no notable
damage to the ASEAN region throughout its history. The negotiation and
enactment of agreements and declarations have aimed at deeper integration
that was further strengthened by the signing of the ASEAN Charter. In terms
of economic issues, such negotiations and mere talks became technically
LIN Chun, Hung. "ASEAN Charter: Deeper Regional Integration Under
International Law?." Chinese Journal Of International Law 9.4 (2010): 821837. Academic Search Complete. Web. 16 May 2012.
9
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binding. This was evidenced in the 2009 ASEAN Trade in Goods Agreement,
the 2008 Manila Declaration on Intensifying ASEAN Minerals Cooperation,
and the 2009 ASEAN Comprehensive Investment Agreement.8 The region has
attained its economic freedom in the trade and movement of goods.
The MRA on medical doctors may need more than just negotiations
and mere talks because there are several stakeholders that come into play.
As the ASEAN aspires for a free trade area, there is a question of whether
health professionals are to be treated as a health commodity or a public
good. It can be argued that the health professionals should be distinguished
from the health services that they provide. Goods and services that benefit
everyone in the community characterize a public good. It is financed and
regulated by a governing body or a model. If the famous quote, Healthcare
is a human right! is to be applied, then it should be suffice to say that health
services are meant to be a public good. On the other hand, unlike a public
good such as food and clothing that is traded among member states, the
demand for healthcare cannot be predicted.Consumers avail of this good if
the time calls for it. There is now a shift in the perspective of how medical
doctors should be viewed. Medical doctors are now seen as commodities
instead of public goods because the product and the activity of production
that they produce are identical. In Talcott Parsons terms, there is a
collectivity-orientation, which distinguishes medicine and other professions
from business, where self- interest on the part of the participants is the
accepted norm.(American Economic Review of 1963)
The movement of medical doctors, being a commodity, takes a
different approach. Voluntary compliance with member countries are not
enough because there is no recourse for the ASEAN system on how State
governments should implement the measures. There are also no mechanisms
for calling Member States to account in case of non- compliance with binding
agreements.8The MRA may need to form central institutions to uphold
member countries compliance with its terms and standard however, unlike
the EU, the leaders of the ASEAN do not agree in having a supranational
institution because this would compromise their domestic sovereignty. As
stated,
due to nationalistic pressures, the ASEAN leaders
have to safeguard their domestic economies and protect
jobs first instead of pushing ahead with ASEAN
integration. With such pressures, there is a risk that the
budding endeavors for regional integration could turn
into
intense
competition
and
possible
political
confrontation rather than cooperation. To deter past
hostilities from creating present and future roadblocks,
to achieve regional identity and to ensure future
integration, there are still a multitude of steps to be
achieved among ASEAN members.8
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The revenues from foreign patients in the year 2005- 2006 in Thailand
reached US$1 billion. Similarly, Singapore targets 1 million foreign patients
in the year 2012 to reach US$2.3 billion. This goes to show that the increase
in qualified professionals in the host country in the ASEAN could attract more
people to the country to avail of its services. On the other hand, there are
several factors that contribute to these countries success medical tourism.
Excess health care has opened the countries doors to medical tourism. In
the case of the Philippines, providing adequate health services is still ongoing
and yet it has already opened its doors to medical tourism. Such incident
could produce a negative impact on the public health care system. Revenues
of the host country are forecasted to increase thus, contributing to economic
growth only if the government could see the MRA as both an opportunity and
a challenge. With appropriate interventions, countries that are coined as
factories of medical doctors could change the scenario by luring in more
ASEAN medical doctors and if possible, improve on the existing public health
care system at the same time.
As the MRA promotes medical tourism, it could further aggravate the
issue of brain drain among ASEAN countries. Brain drain, originally coined by
the London Evening Standard on January 7, 1963, is the term popularly used
when there is a migration of a university trained professional, in this case
that of medical doctors, from one country to another. The figure below shows
that Singapore and Malaysia import the medical doctors for both domestic
and international demand. Philippines and Indonesia are the main exporters
of medical doctors in the ASEAN region.
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that the country uses English as its mode of instruction. Some say that the
public health institutions are not ready for it but this doesnt translate to the
hindered growth of the Philippine Medicine Industry. The downside however
is that the majority of medical doctors in the country are ignorant about the
implementation of MRA on 2015.
PHILIPPINES PERSPECTIVE
When Philippines had the MRA, the Department of Health (DOH) was
not primarily involved. It started with the side of the Department of Trade
and Industry (DTI). When DTI signed it, it was the only time that health
sector became involved with it.
It is the lack of understanding regarding the MRA which is the issue
now, states Dr. Kenneth G. Ronquillo, the Director IV of Health Human
Resource Development Bureau of the Department of Health (DOH). ASEAN is
hastening the full implementation of the MRA of health and tourism by 2015.
It lacks advocacy in the Philippines.
Looking at the MRAs, it is the Philippine Regulations Commission
(PRC), the regulatory body in the country that is responsible for these.
Apparently, even the PRC is not adept with the knowledge of what MRA is all
about including its terms and conditions. It is DOH that is attending the
meetings on behalf of PRC. Lately, with the new PRC chair, that was the only
time that the PRC Board of Medicine became involved. Even then, DOH is the
department giving out the information to the PRC Board of Medicine as well
as giving out advocacy to Philippine Medical Association (PMA). The PMA is
considered not to be a group that will provide information to all doctors
because it has no capacity to inform the whole members of PMA. In the
Board of Medicine, the PRC has no venue to advocate the MRA in the medical
industry. The knowledge has been limited. Because of its limitations, the
medical industries think that the country is bringing in foreign medical
doctors to practice in the Philippines. Medical industries do not see the
opportunity of medical doctors to go out of the country. In addition, these
industries also dont know that there is a structured process. The capacities
of each of the countries are first looked at. Also, the ASEAN is still in the
process of looking at the equivalences of medical doctors with other ASEAN
countries. Furthermore, the ASEAN checks which among the ten member
countries are prepared and ready for the full implementation of the MRA.
Philippines, Malaysia, Singapore, Brunei, and Thailand are the more
developed countries compared to the rest.
One of the reasons why the MRA is being pushed for is the opportunity
for the ASEAN member states, specifically the five less developed countries,
to be parallel or at par with the leading ASEAN countries. This was the start
of creating the roadmaps of each of the countries. The ASEAN secretary
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stated that each country should have a roadmap in order to implement the
MRAs. On the other hand, the five leading countries of the ASEAN have
different stance in the MRAs. Singapore, Brunei and Thailand, are already
accepting foreign medical specialists. Philippines, on the other hand, cannot
accept foreign medical specialists because its constitution dictates that only a
Filipino citizen can practice medicine in the country. Because of this, other
countries are questioning the involvement of the Philippines in the MRA. This
issue paved the way for the formulation of the ASEAN Roadmap. This was
created to know what is needed from each member states and what is
needed to formulate exchanges among member states that could be
beneficial for all parties involved.
The ASEAN Roadmap opened the transparency of member states
regarding the rules and regulations, education towards medicine, its
equivalence with other member countries, and what kind of exchanges could
happen. The creation of the ASEAN roadmap was the only time that doctors
in the ASEAN talked about the MRA on medical doctors. On the other hand,
when the issue was to be passed on to the Medical Association of the ASEAN,
they never talked about the MRA on medical doctors. They talked about
technology, improving their craft, conduct of ethics, but never talked about
the movement of people.
The level of MRA today is still in the process of comparing policies.
Member countries are still looking at equivalences as far as the medical
degrees are concerned. There are countries that do not have licensure
exams. There are countries that have their regulatory bodies under the
ministries of health unlike the Philippines that has a body called the
Professional Regulations Commission (PRC). Others do not have a PRC but
they have their councils. (Appendix A) Because of this, the ASEAN needs to
compare the regulatory bodies among the ASEAN states (ex. Is the PRC
equivalent to a countrys council?) Such step is still an ongoing process.
If the implementation is to begin in the Philippines in 2015, it has both
its advantages and disadvantages to the country. In the positive side, the
MRA will be able to expand its market. Filipinos will be all over the ASEAN
member states. Also, we will be able to improve the countrys technology
because Singapore and Thailand will be influencing the countrys health care
systems. In contrast to this, the country can lose Filipino doctors although
such impact is still unclear since we havent explored the possibility of having
other ASEAN medical doctors come in the country. There are Vietnamese and
Singaporean medical doctors that have expressed their desire and willingness
to practice in the Philippines. An exchange between the Philippines with these
countries is most likely to happen.
The issue is the terms and conditions that are to be discussed within
the MRAs implementing guidelines, states Dr. Ronquillo. This issue
however, has not yet been fixed. For example, the Philippines might not need
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surgeons from other countries because the country already has a lot of
surgeons but what the country may need is faculty. Also, since the country
only has a certain number of cancer specialists, Singapore can provide
Philippines with such in exchange for a certain specialty doctor that its
country needs. These are the exchanges that needed to be included in the
MRA. The MRA on medical doctors really depends on the terms and
conditions that are to be written within the framework of the MRA.
The full implementation of the MRA by 2015 does not imply to all
ASEAN member states. The ASEAN secretariat states that the
implementation of the MRA does not translate to all ten member countries at
once. If only five countries are ready for the MRAs full implementation, then
they would only be the member states that would first spearhead the
arrangement. Later on, when the other member states have been
upgraded, then they will follow on the implementation of the MRA. In Dr.
Ronquillos own personal view, Philippines is actually helping Cambodia with
its health care educational system. It will take time for Cambodia to be at par
with the Philippines. Within the framework of MRA, Cambodia might be left
behind. Cambodia may have the Philippines to help them but what happens
to other member states such as Laos PDR that are not getting any
assistance? The country is still asking for training and technical assistance.
At present, Brunei has no school of medicine but is currently
developing their school of nursing. Brunei has no existing universities but
they have the capacity to bring their citizens outside to study then to return
back to their home country. The Philippines can then have an agreement with
Brunei since they provide scholarships outside their country but never in
theirs. The country hopes of having a medical school sometime as well. For
now, Brunei is still sending people outside to study in order to create a
critical pool of medical doctors that could run their own medical school.
Philippines has universities that could cater to their need of training to
become a medical doctor back in their home country.
To avoid the threat that the Philippines becomes a factory of medical
doctors, there is a need to craft the rules and regulations of the framework
with care. Philippines can put quotas to medical schools by indicating a
certain percentage for foreign medical students. This should be properly
imposed because at present, Philippines is still in the stage of having an
open business. Myriad of medical schools in the country continue to accept
foreign students without having any limitations because of its profit
orientation. CHED has to come up with such policy once it reaches the full
implementation of the MRA.
Review of ASEAN member states equivalencies in education and
policies is the first step before full implementation. Although the targeted
year is at 2015, the readiness of the Philippines is still doubtful. The
implementation of the MRA may mean for example, just for oncologists,
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have its full implementation by 2015. The MRA on medical doctors has been
made together with the nursing and dental professionals. The issue regarding
its application is questionable at present. Myriad of factors come into play if
harmonization is to take place in order to achieve an MRA that will benefit all
its stakeholders.
The implementation of the MRA speaks much of freedom. It is the
freedom of Economic freedom is defined as the freedom of individuals to
specialize, exchange goods and services, compete in markets, and enjoy the
outcome they invested in As ASEAN does not have a body that governs
domestic policies of each country, freedom does not spread as easily as that
in EU. In addition, countries in Asia do not share the same boundaries due to
geographic location that bodies of water hinder the movement of freedom
from one country to the other.
Freedom spreads from one country to the other. Such an idea came
about because of the domino theory wherein the economic standing, whether
prosperous or not, can infect countries successively either for its geographic
location or through trade proven by econometric model that used panel data.
the average level of economic freedom of a country's neighbors (or trading
partners) were to rise by one unit in the Summary Economic Ratings, the
country in question would experience a 0.2 unit increase units Economic
Freedom Rating (Gwartney and Lawson 2007, 30).
Trade is another medium for economic freedom to spread and this is
what the MRA stands for. For example, when a developed country
experiencing high economic freedom is able to export more products,
resources, or wealth, to other developing countries experiencing low
economic freedom, the receiving country experiencing the economic gains
will more likely increase their economic freedom domestically because they
would want to acquire more. When trade happens between these countries,
the country with high economic freedom influences the country with low
economic freedom to also to participate in domestic and international trade.
All countries undergo fallbacks or instability in the economy since they
are sometimes unavoidable but the policy that politicians implement to help
the country bounce back to a higher state is the important factor. The
implementation of the policy should not only take into account the positive
effects in the economy whether in the long run or short run but also the
weight that goes to the citizens since they are the producers and consumers
in the market.
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BIBLIOGRAPHY
Amin, Zubair, KhooHoon Eng, et al. Medical education in Southeast Asia:
emerging issues, challenges and opportunities. Medical Education39:8
(2005) Web. 14 May 2012.
Arunanondchai, Jutamas, and Carsten Fink. "Trade In Health Services In The
ASEAN Region." Health Promotion International 21.(2006): 59. EDS
Foundation Index. Web. 16 May 2012.
ASEAN : The Next 30 Years. Saffron Walden, Essex, U.K. : World of
Information, c1998., 1998. Rizal Librarys OPAC (Online Catalog). Web. 16
May 2012.
ASEAN Roadmap for the Integration of the Healthcare Sector. ASEAN- US
Technical Assistance and Training Facility. Executive Summary.
ASEAN Tourism Strategic Plan 2011- 2015.
Barber, Sarah L., Paul J. Gertler, and PanduHarimurti. "The Contribution Of
Human Resources For Health To The Quality Of Care In Indonesia." Health
Affairs 26.(2007): w367-w379. Academic Search Complete. Web. 16 May
2012.
Cortez, Nathan. "International Health Care Convergence: The Benefits And
Burdens Of Market-Driven Standardization." Wisconsin International Law
Journal 26.(2008): 646. LexisNexis Academic: Law Reviews. Web. 16 May
2012.
Chia, SiowYue, and Loong-Hoe Tan. ASEAN & EU : Forging New Linkages And
Strategic Alliances / Edited By ChiaSiowYue, Joseph L.H. Tan. Singapore :
Institute of Southeast Asian Studies , c1997, 1997. Rizal Librarys OPAC
(Online Catalog). Web. 16 May 2012.
Chongsuvivatwong,Virasakdi, Kai Hong Phua, et al. Health and health- care
systems in southeast Asia: diversity and transitions. The Lancet 377: 429- 37
(2011). Web. 12 May 2012.
Davis, Lucy, and Fredrik Erixon. "The Health Of Nations." Fraser Forum
(2008): 28-31. Business Source Complete. Web. 16 May 2012.
Desierto, Diane A. "ASEAN's Constitutionalization Of International Law:
Challenges To Evolution Under The New ASEAN Charter." Columbia Journal
Of Transnational Law 49.(2011): 268. LexisNexis Academic: Law Reviews.
Web. 16 May 2012.
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APPENDICES
Appendix A
ASEAN Mutual Recognition Arrangement on Medical Practitioners
PREAMBLE
The Governments of Brunei Darussalam, the Kingdom of Cambodia, the
Republic of Indonesia, the Lao Peoples Democratic Republic, Malaysia, the
Union of Myanmar, the Republic of the Philippines, the Republic of Singapore,
the Kingdom of Thailand, and the Socialist Republic of Viet Nam, Member
States of the Association of South East Asian Nations (hereinafter collectively
referred to as ASEAN or ASEAN Member States or singularly as ASEAN
Member State);
RECOGNISING the objectives of the ASEAN Framework Agreement on
Services (hereinafter referred to as AFAS), which are to enhance cooperation
in services amongst ASEAN Member States in order to improve the efficiency
and competitiveness, diversify production capacity and supply and
distribution of services of their services suppliers within and outside ASEAN;
to eliminate substantially the restrictions to trade in services amongst ASEAN
Member States; and to liberalise trade in services by expanding the depth
and scope of liberalisation beyond those undertaken by ASEAN Member
States under the General Agreement on Trade in Services (hereinafter
referred to as GATS) with the aim to realising free trade in services;
RECOGNISING the 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 highly competitive
ASEAN Economic Region which would result in:
NOTING that Article V of AFAS provides that ASEAN Member States may
recognise the education or experience obtained, requirements met, or
licences or certifications granted in another ASEAN Member State, for the
purpose of licensing or certification of service suppliers;
NOTING the decision of the Bali Concord II adopted at the Ninth ASEAN
Summit held in 2003 calling for the completion of Mutual Recognition
Arrangements (hereinafter referred to as MRAs or singularly as MRA) for
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PMRA
BruneiDarussalam
BruneiMedical Board
Cambodia
Indonesia
Lao PDR
Ministry of Health
Malaysia
Myanmar
Philippines
Singapore
Thailand
Viet Nam
Ministry of Health
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ARTICLE VI
ASEAN JOINT COORDINATING COMMITTEE ON MEDICAL
PRACTITIONERS
6.1 An ASEAN Joint Coordinating Committee on Medical Practitioners
(hereinafter referred to as AJCCM) shall be established comprising of not
more than two (2) appointed representatives from the PMRA of each ASEAN
Member State with the following terms of reference:
6.1.1 to facilitate the implementation of this MRA through better
understanding of the Domestic Regulations applicable in each ASEAN Member
State and in the development of strategies for the implementation of this
MRA;
6.1.2 to encourage ASEAN Member States to standardise and adopt
mechanisms and procedures in the implementation of this MRA;
6.1.3 to encourage the exchange of information regarding laws, practices
and developments in the practice of medicine within the region with the view
of harmonisation in accordance with regional and/or international standards;
6.1.4 to develop mechanisms for continued information exchange as and
when needed;
6.1.5 to review the MRA every five (5) years or earlier, if necessary; and
6.1.6 to do any other matters related to this MRA.
6.2 The AJCCM shall formulate the mechanism to carry out its mandate.
ARTICLE VII
MUTUAL EXEMPTION
7.1 The ASEAN Member States recognise that any arrangement which would
confer exemption from further assessment by the PMRA of the Host Country
may be concluded only with the involvement and consent of that PMRA.
7.2 The ASEAN Member States note that the PMRA of the Host Country has
the statutory responsibility of protecting the health, safety, environment, and
welfare of the community within its jurisdiction, and may require the Foreign
Medical Practitioners seeking the right to practise in the Host Country to
submit themselves to some form of supplementary requirements or
assessment.
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ARTICLE X
FINAL PROVISIONS
10.1 The terms and definitions and other provisions of the GATS and AFAS
shall be referred to and shall apply to matters arising under this MRA for
which no specific provision has been made herein.
10.2 This MRA shall enter into force six (6) months after the signing of this
MRA by all ASEAN Member States. Any ASEAN Member State that wishes to
defer implementation of this MRA shall notify the ASEAN Secretariat in
writing of its intention within 6 months from the date of signature and the
ASEAN Secretariat shall thereafter notify the rest of the ASEAN Member
States. The deferment shall be effective upon notification by the ASEAN
Secretariat to the other ASEAN Member States.
10.3 Any ASEAN Member State which has, pursuant to Article 10.2 of this
MRA, given notice of deferment of its implementation, shall notify the ASEAN
Secretariat of the indicated date of implementation of this MRA, which shall
not be later than 1 January 2010. The ASEAN Secretariat shall thereafter
notify the rest of the ASEAN Member States of the indicated date of
implementation of this MRA. An ASEAN Member State which does not notify
the ASEAN Secretariat of its date of implementation by 1 January 2010 shall
be bound to implement this MRA on 1 January 2010.
10.4 This MRA shall be deposited with the ASEAN Secretariat, who shall
promptly furnish a certified copy thereof to each ASEAN Member State.
IN WITNESS WHEREOF, the undersigned, being duly authorised thereto by
their respective Governments, have signed this ASEAN Mutual Recognition
Arrangement on Medical Practitioners.
DONE at Cha-am, Thailand, this Twenty Sixth Day of February in the Year
Two Thousand and Nine, in a single original copy in the English Language
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For Malaysia:
U SOE THA
Minister for National Planning and Economic Development
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PETER B. FAVILA
Secretary of Trade and Industry
VU HUY HOANG
Minister of Industry and Trade
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