Assignment: Demand for Private Healthcare in A Universal Public Healthcare System

Assignment: Demand for Private Healthcare in A Universal Public Healthcare System ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Demand for Private Healthcare in A Universal Public Healthcare System Please you must read the two articles so you can write your thoughts and ideas about health services provided in the private for-profit sector in those countries or others . The two articles explained health services provided for profit sector. After reading the two articles write your thoughts and answer any of these questions below. Assignment: Demand for Private Healthcare in A Universal Public Healthcare System We are focusing on health services provided in the private for-profit sector. While the emphasis is on health services delivery linked to the HSS framework and building blocks we also want to consider the role of the for-profit and corporate sector in other aspects of health systems, e.g. drugs, new technologies, health information systems, data gathering and analysis, research and development. Clearly there are many aspects to explore. The role of profit in health systems has a long and sometimes contentious history in public/global health circles. 1. Is this skepticism driven by evidence or ideology or both? 2. How does the for-profit sector address the challenges/skepticism? 3. What is the states role in regulating, monitoring and evaluating for-profit provision of care? 4. Are there fundamental equity differences that arise from a pluralistic approach to health services delivery? What is the appropriate public policy response? Assignment: Demand for Private Healthcare in A Universal Public Healthcare System medical_tourism_and_policy_implications_for_health_systems.pdf demand_for_private_healthcare_in_a_universal_public_health_system_sri_lanka.pdf Pocock and Phua Globalization and Health 2011, 7:12 REVIEW Open Access Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia Nicola S Pocock* and Kai Hong Phua Abstract Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism’s growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism’s impact on health systems. Introduction Growing demand for health services is a global phenomenon, linked to economic development that generates rising incomes and education. Demographic change, especially population ageing and older people’s requirements for more medical services, coupled with epidemiological change, i.e. rising incidence of chronic conditions, also fuel demand for more and better health services. Waiting times and/or the increasing cost of health services at home, coupled with the availability of cheaper alternatives in developing countries, has lead new healthcare consumers, or medical tourists, to seek treatment overseas [1]. The correspondent growth in the global health service sector reflects this demand. The globalisation of healthcare is marked by increasing international trade in health products and services, strikingly via cross border patient flows. * Correspondence: [email protected] Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, OTH Building, Singapore 259772, Singapore In Southeast Asia, the health sector is expanding rapidly, attributable to rapid growth of the private sector and notably, medical tourism, which is emerging as a lucrative business opportunity. Countries here are capitalising on their popularity as tourist destinations by combining high quality medical services at competitive prices with tourist packages. Some countries are establishing comparative advantages in service provision based on their health system’s organizational structure (table 1). Thailand has established a niche for cosmetic surgery and sex change operations, whilst Singapore is attracting patients at the high end of the market for advanced treatments like cardiovascular, neurological surgery and stem cell therapy [2]. In Singapore, Malaysia and Thailand alone, an estimated 2 million medical travellers visited in 2006 – 7, earning these countries over US$ 3 billion in treatment costs (table 2). Carrera and Bridges (2006) define medical tourism as “the organized travel outside one’s natural healthcare © 2011 Pocock and Phua; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution LicenseAssignment: Demand for Private Healthcare in A Universal Public Healthcare System (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pocock and Phua Globalization and Health 2011, 7:12 Page 2 of 12 Table 1 Health systems in comparison [3] Country Thailand Malaysia Singapore Organizational structure Pockets of excellence in some private Bangkok hospitals Growing private health sector with movement of qualified workforce Balanced public-private mix, corporatized public sector Industrial strategy to develop tourism Economic growth strategy to develop biomedical industries Regional service hub National strategy Regional health hub Extensive tourism infrastructure Medical R&D support Policy impact Issues of growing inequity and urbanrural divide Public-private divide Narrow income gaps of public and private sectors Racial inequities between public and private sectors jurisdiction for the enhancement or restoration of the individual’s health through medical intervention”, using but not limited to invasive technology. The authors define medical tourism as a subset of health tourism, whose broader definition involves “the organized travel outside one’s local environment for the maintenance, enhancement or restoration of the individual’s wellbeing in mind and body”. Importantly, their definition of medical tourism takes into account the territorially bounded nature of health systems, where access to healthcare is often but not always limited to national boundaries [6]. Medical tourism constitutes an individual solution to what is traditionally considered a public (government) concern, health for its citizens, who at the micro level are responding to market incentives by seeking lower cost and/or high quality care overseas that cannot be found at home. These tourists may be uninsured or underinsured. Travelling overseas for medical care has historical roots, previously limited to elites from developing countries to developed ones, when health care was inadequate or unavailable at home. Now however, the direction of medical travel is changing towards developing countries [7], and globalization and increasing acceptance of health services as a market commodity [8] have lead to a new trend; organized medical tourism for fee paying patients, regardless of citizenship, who shop for health services overseas using new information sources, new agents to connect them to providers, and inexpensive air travel to reach destination medical [9]. The impact of medical tourism on health systems is as yet unknown due to a dearth of data and empirical analysis of the phenomenon. Governments are noticeably playing a strong marketing and promotional role in the emerging medical tourism industry. This is a clear trend in Southeast Asia, especially in Thailand, Singapore and Malaysia, the main regional hubs for medical tourism, where medical tourist visas are available and government agencies have been established with the mandate to increase medical tourist inflows [10]. Governments in Indonesia, the Philippines and Vietnam have also expressed interest in promoting the industry. The potential economic benefits of medical tourism make it an attractive option for governments. Medical tourism can contribute to wider economic development, which is strongly correlated with improved population health status as a whole, e.g. increased life expectancy, reduced child mortality rates [11].Assignment: Demand for Private Healthcare in A Universal Public Healthcare System Encouraging foreign direct investment in healthcare infrastructure and medical tourist inflows with correspondent revenue can create additional resources for investment in health care [12]. Furthermore, medical tourism may slow or reverse the outmigration of health workers, particularly of specialists [13]. However, health systems in some of these countries face challenges in ensuring basic health service coverage for their own citizens [3]. Two tier healthcare provision Table 2 Export of health services [2,4,5] Estimated earnings Thailand (2006) Singapore (2007) Malaysia (2007) No. foreign patients Baht 36 billion 1.4 million (US$ 1.1 billion) S$ 1.7 billion 571 000 (US$ 1.2 billion) 341 288 253.84 million MYR (US$78 million) Origin of patients (in order of volume) Specialty Japan, USA, South Asia, UK, Middle East, ASEAN countries Indonesia, Malaysia, Middle East Cosmetic and sex change surgery Indonesia, Singapore, Japan, India, Europe Cardiac and neuro surgery, joint replacements, liver transplants Cardiac and cosmetic surgery Pocock and Phua Globalization and Health 2011, 7:12 has emerged in Malaysia, with private services limited to those who can afford it and public services for the rest of the population [14]. Thailand’s public to private health worker brain drain has strained public health provision, especially in rural areas [15,16]. Trade in medical supplies, organs, pharmaceuticals and health worker migration have dominated policy debates about the impact on health systems in developing countries, including concerns about intellectual property rights and access to affordable drugs, the latest medical technology, and retaining doctors and nurses within the public sector and/or within the country’s health system at all. There are growing concerns about the impact of medical tourism on health systems, particularly equity of access for both foreign and local consumers [17]. Inequities at home, either by low quality services and/or inability to pay, prompt people to seek cheaper and high quality care treatment overseas. As Blouin (2010) contends, a policy question that remains unanswered is whether medical tourism can improve the capacity of poor people in developing countries to access health services. She calls for the exploration of policy mechanisms that mitigate the risks associated with medical tourism, whilst harnessing the potential benefits, for local consumers [18]. In the academic literature, conceptual analyses of medical tourism have emerged from a tourism management perspective, analysing supply and demand factors [19-22], and as a node in the trade in health perspective [10,23-26]. Legal literature is beginning to cover patient liability issues when surgery is carried out overseas [27]. Recent work has begun to analyse medical tourism and its potential impact on health systems in specific countries [1,28,29]. Yet not all health systems functions are analysed in these accounts. A core concern is whether medical tourism diverts resources from public components of health systems in destination countries [30]. Furthermore, conceptual frameworks in the health systems literature focus on the impact of targeted, vertical interventions in health systems [31]. But medical tourism is a phenomenon rather than an intervention; its policy implications have yet to be considered within the context of a health system. This paper presents a conceptual framework of medical tourism and policy implications for health systems in Southeast Asia, drawing on the cases of Thailand, Singapore and Malaysia, via an extensive review of the academic and grey literature, as well as insights from health consultancies in the public and private sectors across the region.Assignment: Demand for Private Healthcare in A Universal Public Healthcare System This framework provides a basis for more detailed country specific studies on the benefits and disadvantages of medical tourism, of special relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in Page 3 of 12 facilitating the growth of the medical tourist industry. Bridging the social science disciplines, the public policy approach to research is a pragmatic one, with the end goal of translating research into useful policy recommendations, in this instance those that optimise the benefits of medical tourism for both foreign and local consumers and mitigate the risks. Research methodology is outlined below, followed by the policy implications of medical tourism for health systems at their governance, delivery, financing, human resources and regulation functions [32,33]. The conclusion emphasizes the need for concerted data collection efforts and identifies variables for further analysis of medical tourism’s potential impact on health systems. Research methodology Media reports on the medical tourism industry and participation in regional conferences enabled the researchers to pinpoint Singapore, Thailand and Malaysia as the three main hubs for medical tourism in Southeast Asia for comparative analysis. Broadly, there are four types of comparative health policy analyses. The first constitute descriptive studies, with no hypothesis or testing of explanations on why patterns exist, leaving policy explanations implicit for the reader to gauge. The second include collections of international case studies with some assessment of performance, whilst the third type includes studies employing a common framework for analysis (e.g. privatization). The fourth type of cross national studies are those that show a fundamental theoretical orientation, with a specific theme or question as a focus of analysis (Marmor et al 2005: 341 – 2) [34]. We decided to undertake this fourth type of comparative analysis, in order to generate a conceptual framework that could be usefully employed by policymakers to understand the policy implications of medical tourism on health systems with similar structures. Methods employed focussed on conceptualising rather than describing, where one or more new concepts are developed to explain what is being studied [35]. An inductive, theory building approach [36] is appropriate to examine medical tourism where knowledge is far lacking, especially in relation to health systems. An initial informal literature scan using the search criteria “medical tourism AND Asia” in google scholar revealed a lack of data and authoritative sources on medical tourism, particularly figures for number of patients and estimated earnings. Academic literature was searched exhaustively in the PubMed and Social Science Research Network databases using the search criteria “medical tourism AND Asia” (92) and “medical travel AND Asia” (806), generating a range of mostly conceptual research. Abstracts were scanned for reference to Thailand, Singapore and Malaysia and/or reference to health systems in general. Additional articles were located using the Pocock and Phua Globalization and Health 2011, 7:12 reference list of selected articles. Study selection was not systematic; no article was omitted but considered in the context of health systems/medical tourism in Asia (43). Articles gathered were then categorised according to content focus (e.g. privatisation of health systems, medical tourism empirical evidence, health and trade nexus). Following categorisation, all articles were analysed to identify medical tourism interaction points across the health system functions, with new material continually brought into the analysis. Concurrent to the theory building process, quantitative data on the nature of health systems in the three study countries were retrieved from official country sources and the World Health Organization. These data were triangulated with the academic literature to validate claims made about the nature of health systems. Assignment: Demand for Private Healthcare in A Universal Public Healthcare System This data also enabled the researchers to make systematic comparisons between the three country health systems. Following this step, grey literature were searched using the above search criteria in Factiva, a news item database, to provide examples of recent developments in the medical tourist industry in the three study countries. Other grey literature sources included management consultancy research reports, working papers on medical tourism, and medical tourism industry player’s statistics and promotional materials. Subsequent to analysis and identification of the conceptual framework, potential policy options were outlined based on the literature and/or innovative examples of comparative health policy responses in the region. We anticipated that the different nature of health systems (e.g. mostly public versus private delivery) would also generate differential policy implications according to local context. In the course of our comparative analysis, we found this to be the case to a large extent; however, medical tourism poses potential risks and benefits regardless of the current nature of a health system. As a phenomenon, it can fundamentally change the nature of health systems themselves without policy intervention (e.g. shift towards a dominantly private hospital sector). Thus, the policy implications described are broadly applicable to health systems in general, but of particular relevance to policymakers and industry practitioners in other Southeast Asian countries where governments have expressed an interest in developing the medical tourist industry. Results Governance in separate domains of trade and health Medical tourism straddles the policy domains of trade and health. Its rise is situated within the rapid growth of trade in health services, driven by increased international mobility of service providers and patients, advances in information technologies and communications, and an expanding private health sector [10]. Trade by definition is international, but health systems (financing, delivery Page 4 of 12 and regulation) remain nationally bounded. Additionally, trade objectives of increased liberalisation, less government intervention and economic growth generally do not emphasize equity, whereas health sector objectives like universal coverage do. Assignment: Demand for Private Healthcare in A Universal Public Healthcare System Consequently, actors in the trade and health policy spheres tend to have conflicting objectives, and trade and health governance processes remain relatively separate at three levels; the international (World Trade Organisation (WTO) and World Health Organisation (WHO)), regional (Association of South East Asian Nations (ASEAN)) and national (government ministries). Reconciling the aims of economic growth with equitable health service provision and access makes governance of medical tourism within a country’s health system challenging at best and contradictory at worst. At the international level, there are clear tensions between the goals of protecting and promoting health and generating wealth through trade [23]. Trade and health policy negotiations occur in isolation, despite the growing importance of the trade and health nexus at the global level, e.g. extensive health worker migration and cross border consumption of health services (medical tourism) [10,23]. WTO membership requires adherence to a multitude of legally binding obligations, including removal of tariff and non tariffs barriers on goods and services. The WTO’s formal governance architecture is embodied in its legally binding trade agreements and compulsory legal dispute mechanism. These legal apparatus afford it more compliance clout than the WHO, which by contrast is an advocacy organization. The WHO imposes no legal obligations on members, relies on non binding agreements, and has no compulsory dispute mechanism. Thus enforcement capacity in cases of non compliance to WHO agreements is limited [23]. Economic growth and trade considerations are likely to surpass health objectives at the global level when countries face sanctions or legally punitive measures for non compliance with trade agreements. Examples of trade and health policy incoherence include patents on essential medicines and tobacco promotion in developing countries, permitted by trade agreements [37]. Whilst most trade in health services takes place outside the framework of existing trade agreements, whether bilateral or multilateral [25], trade in health services including medical tourism is officially provisioned for under the … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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