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TradeinHealthService s130207

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Information about TradeinHealthService s130207
Education

Published on March 28, 2008

Author: Dabby

Source: authorstream.com

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Trade in Health Services… Good for Thailand ???:  Wattana S. Janjaroen 13-02-07 1 Trade in Health Services… Good for Thailand ??? Wattana S. Janjaroen, Ph.D. Faculty of Economics Chulalongkorn University 13 February 2007 Topics:  Wattana S. Janjaroen 13-02-07 2 Topics Background Potential of trade in health service sector Consequences of trade in health services What should we do? Slide3:  Wattana S. Janjaroen 13-02-07 3 Wattana S. Janjaroen 13-12-00 3 GATT, WTO, AFTA , APEC TRIPS, GATS, LAW, REGULATION, ETC Slide4:  Wattana S. Janjaroen 13-02-07 4 Summary of industry-specific commitments scheduled by Asia/Pacific trading partners, by industry, under GATS. Slide5:  Wattana S. Janjaroen 13-02-07 5 Wattana S. Janjaroen 13-12-00 5 Slide6:  Wattana S. Janjaroen 13-02-07 6 Slide7:  Wattana S. Janjaroen 13-02-07 7 1. CROSS - BORDER TRADE 2. CONSUMPTION ABROAD 3. COMMERCIAL PRESENCE 4. MOVEMENT OF PERSONNEL MODE OF SUPPLY Slide8:  Wattana S. Janjaroen 13-02-07 8 Potential areas of trade in health services in Thailand Consequences:  Wattana S. Janjaroen 13-02-07 9 Consequences Impacts of trade in health services on national health sector using a framework of equity and quality. Impacts of trade in health services on national health system To explore the possibility of public sector competing in trade in health services and their implication on health system. Research Methodology:  Wattana S. Janjaroen 13-02-07 10 Research Methodology Research Design Economic Tools Research Design:  Wattana S. Janjaroen 13-02-07 11 Research Design Cross-sectional Study : 2005 Target population : patients in private and public hospital with 300 bed + and hospital managers and experts Sample size Sampling method Sample Size:  Wattana S. Janjaroen 13-02-07 12 Sample Size Where: n = Number of items in samples Z2 = The square of the confidence interval in standard error units. p = Estimated proportion of success = 0.6 q = (1-p) or estimated the proportion of failures = 0.4 E2 = The square of the maximum allowance for error between the true proportion and sample proportion = 576 ~ 600 samples Sample hospitals:  Wattana S. Janjaroen 13-02-07 13 Sample hospitals One private hospital each from the north, northeast, south and west region Two private and two public hospitals in Bangkok 75 samples both outpatient and inpatient from each hospital The samples were interviewed at their own willingness to participate. Experts/hospital manager from each hospital Economic tools:  Wattana S. Janjaroen 13-02-07 14 Economic tools Descriptive statistics--- secondary data, questionnaires and in-depth interview Logit model : data needed --- questionnaires Concentration Index--- secondary data sources Herfindahl Summary Index (HSI) Comprehensive Concentration Index (CCI) Entropy Index Logit Model:  Wattana S. Janjaroen 13-02-07 15 Logit Model Zi =  + Xi General form Z = 0 + 1SEX + 2MARITAL + 3EDU + 4BUS + 5GOV + 6 PRIVATEIN + 7P1 + 8P2 + 9P3 + 10P4 + 11P5 + 12P6 + 13TIME Slide16:  Wattana S. Janjaroen 13-02-07 16 Where : Z = dummy variable indicating choice of services Z = 1, if the patient uses a private hospital Z = 0, if the patient uses a public hospital  SEX = dummy variable indicating patient’s gender SEX = 1, if the patient was male SEX = 0, if the patient was female MARITAL = dummy variable indicating patient’s marital status MARITAL = 1, if married MARITAL = 0, if not married EDU = dummy variable indicating level of education EDU = 1, if patient’s education > bachelor degree EDU = 0, if patient’s education < bachelor degree Slide17:  Wattana S. Janjaroen 13-02-07 17 BUS = dummy variable indicating patient’s career BUS = 1, if working in private sector BUS = 0, if otherwise GOV = dummy variable indicating patient’s government employment involvement GOV = 1, if a full-time government employee GOV = 0, if otherwise PRIVATEIN = dummy variable indicating private health insurance benefit PRIVATEIN = 1, if having private health insurance PRIVATEIN = 0, if otherwise P1 = dummy variable indicating rationale for choice P1 = 1, if the patient had a contract with hospital P1 = 0, if otherwise P2 = dummy variable indicating rationale for choice P2 = 1, if the patient was satisfied with the medical services P2 = 0, if otherwise P3 = dummy variable indicating rationale for choice P3 = 1, if chosen for the medical experts’ skill P3 = 0, if otherwise P4 = dummy variable indicating rationale for choice P4 = 1, if recommended by others P4 = 0, if otherwise P5 = dummy variable indicating rationale for choice P5 = 1, if there was a good environment and service P5 = 0, if otherwise P6 = dummy variable indicating rationale for choice P6 = 1, if the price of the service was though reasonable P6 = 0, if otherwise TIME = waiting time in receiving services Slide18:  Wattana S. Janjaroen 13-02-07 18 Results INTERNATIONAL TOURIST ARRIVALS TO THAILAND BY NATIONALITY :  Wattana S. Janjaroen 13-02-07 19 INTERNATIONAL TOURIST ARRIVALS TO THAILAND BY NATIONALITY Source of data : Immigration Bureau, Police Department Slide20:  20 Wattana S. Janjaroen 13-02-07 Concentration index : number of bed in each province:  Wattana S. Janjaroen 13-02-07 21 Concentration index : number of bed in each province Impacts on health system and medical education:  Wattana S. Janjaroen 13-02-07 22 Impacts on health system and medical education Negatives Inequities in access to health care in Thailand would inevitably increase, since there is high competition among health providers to attract the high-end segment of the market, driving the cost of these services upward and hence the prices to be paid, which inhibits domestic inhabitants at relatively lower income levels from gainful access to health care services. The waiting time prior to receiving health services at public hospitals is much longer than that at private hospitals.   There is a problem of ‘brain drain’ of health personnel from public establishments to private hospitals and between private hospitals, especially doctors. This situation increasingly disadvantages lower-income Thai citizens from accessing good quality domestic health care services. The ‘brain drain’ problem is extending to professors at medical schools. This phenomenon is greatly impacting the quality of medical education in the short- and long-terms.   There is some inequity in payment for the same services that occurs mainly at public hospitals. Foreign non-resident patients may pay less on the whole for health services when compared to Thai citizenry because they may not be contributing directly to the government budget through taxation as Thai nationals and foreign legal residents are required to. Slide23:  Wattana S. Janjaroen 13-02-07 23 Resignation Rate of Medical Professors, 2002-2004 Slide24:  Wattana S. Janjaroen 13-02-07 24 Positive   Trade in health services can earn hard currency for the country that undertakes international marketing of health services, where external demand for health care and health-related business can help reduce national trade deficits, or supplement surpluses. There could be a mutual cross-subsidization between the public and private health service sectors via part-time employment of qualified health personnel from the public sector at private hospitals, augmenting the incomes of public sector health service professionals, while not having to totally abandon their duties at public hospitals. The health care service market, especially in large urban centers, is a competitive one. The quality of health services may be improved by competition in meeting more lucrative demand implied by the international market. Potential of public hospital in trade in health services:  Wattana S. Janjaroen 13-02-07 25 Potential of public hospital in trade in health services Less likely : - restriction on government policy, budget - need big investment on health personnel, especially on ability to communicate with foreigners - objectives is maximize health of Thai Recommendations:  Recommendations Wattana S. Janjaroen 13-02-07 26 Slide27:  Wattana S. Janjaroen 13-02-07 27 Slide28:  Wattana S. Janjaroen 13-02-07 28

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