jose y. cueto jr., md, fpcs, mhped · jose y. cueto jr., md, fpcs, mhped philippine representative...

Jose Y. Cueto Jr., MD, FPCS, MHPEd

Philippine Representative to the ASEAN Joint Coordinating Committee for

Medical Practitioners (AJCCM), ASEAN MRA

Member, Professional Regulatory Board of Medicine, PRC

Overall Coordinator, Working Group for International Alignment,

Philippine Qualifications Framework (PQF), PRC

Member, Task Force for the ASEAN Qualifications Reference Framework

(AQRF)

Masters in Health Professions Education, UP National Teachers Training Center

for Health Professions, UP Manila

Residency Training in General Surgery

UP – Philippine General Hospital

Doctor in Medicine

UP College of Medicine

Is the Healthcare Sector Ready

for ASEAN 2015?

Jose Y. Cueto Jr., MD, FPCS, MHPEd

Professional Regulatory Board of Medicine

Representative to the AJCCM

Overall Coordinator, PQF, PRC

17th Midyear Convention of the Philippine College of Chest Physicians

August 6, 2014

ASEAN MRA: what

do we need to

know?

ASEAN Integration

2015: what are the

components?

What will be the

challenges in the

healthcare sector?

Reference to SUBSTANCE of integration

Complete Economic Integration

Economic & Monetary Union

Common Market

Customs Union

Free Trade Areas

Conceptual Framework

RECOGNITION DEVELOPMENT HARMONIZATION

OF QUALIFICATIONS

MOBILITY OF PROFESSIONALS

(ASEAN ECONOMIC COMMUNITY 2015)

MRA PQF AQRF

ASEAN MRA: Most important

issues

What is the basis for the agreement?

What are the eligibility requirements to

move to other countries?

What are the modes of supply of services?

What will be the ultimate form of mobility?

ASEAN Framework Agreement on

Services (AFAS)Article V : Recognition

ASEAN Member States may recognize the

education or experience obtained,

requirements met, or licenses or

certifications granted in another ASEAN

Member State, for the purpose of licensing

or certification of service suppliers.

The ASEAN Mutual Recognition

Arrangements

PROFESSIONAL SERVICES DATE OF SIGNING

1. ENGINEERING Dec. 2005

2. NURSING Dec. 2006

3. SURVEYING Nov. 2007

4. ARCHITECTURE Nov. 2007

5. DENTISTRY Aug. 2008

6. MEDICINE Feb. 2009

7. ACCOUNTANCY Feb. 2009

Recognition and Eligibility of Foreign

Practitioners

1. In possession of a qualification recognized by

PRA of country of origin and host country

2. In possession of a valid professional registration

and current practicing certificate to practice

issued by PRA of country of origin

3. Has been in active practice in country of origin

Engineering/Architecture: 7 years

Medicine/Dentistry: 5 years

Nursing: 3 years

Recognition and Eligibility of Foreign

Practitioners

4. In compliance with CPD requirements

5. Has been certified as not having violated any

professional or ethical standards, local and

international

6. Has declared that there is no investigation or

legal proceeding pending against him/her in the

country of origin or another country

7. In compliance with any other assessment or

requirement as may be imposed by host

country

ASEAN MRA: Recognition

RECOGNITION

OF

QUALIFICATIONS

BY

HOST COUNTRY

PROFESSIONALS

1. In possession of

qualification

2. Valid registration and

license

3. Work experience

4. In compliance with CPD

requirements

5. Certification of not

having violated any

professional or ethical

standards

6. No pending

administrative or legal

proceeding

ASEAN MUTUAL RECOGNITION

ARRANGEMENTS

Right to Regulate - These MRAs shall not

reduce, eliminate or modify the rights,

power and authority of each ASEAN

Member State, its Professional Regulatory

Authority and other relevant authorities to

regulate and control practitioners and the

practice of profession.

1• Cross-Border Supply

2• Consumption Abroad

3• Commercial Presence

4• Movement of Natural Persons

V. Services, unlike goods, have 4 modes of supply

MEMBER A MEMBER B

Mode 1: Cross border supply

Mode 2: Consumption abroad

Mode 3: Commercial presence

Consumer A

The service crosses the border

Service

supply

Service Supplier

Service Supplier

Consumer A

Consumer A

Consumer A

Service Supplier

Commercial Presence

Establishes a commercial presence in AService

supply

Modes of Supply

Mode 4: Movement of natural persons

Naturalperson

Self-employed goes to Member A

MEMBER A MEMBER B

Naturalperson

Consumer A

Consumer A

Commercial Presence

Juridical person

Service

supply

Service

supply

Modes of Supply

Mode 1: Cross Border Supply

Cambodia

Philippine

Hospital

Singapore

Hospital

Mode 1: Cross border supply

Mode 2: Consumption Abroad

Philippines

Singapore

Mode 3: Commercial Presence

Thailand

Mode 4: Movement of natural

persons

Implications for Practice

Mode 1: Cross border supply

Technology-based

Diagnostic radiology

Histopathology

Medical transcription

Medical research

Education: distance learning mode

Implications for Practice

Mode 2: Consumption abroad

(Medical Tourism)

Services offered/Value-added

Diagnostics

Surgical procedures

Minimally invasive procedures

Medical education

Thai students

Residency training/Subspecialty

Indonesia, Nepal, India, Pakistan

Implications for Practice

Mode 3: Commercial presence

Foreign companies invest in the

Philippines

Build tertiary hospitals and diagnostic

centers

May bring their own people with them

Mode: competing or cooperating?

Joint ventures / cooperative undertakings

Implications for Practice

Mode 4: Movement of natural persons

Full/Free mobility: countries with similar education, accreditation, certification systems, and professional practice

US and Canada

Australia and New Zealand

10 ASEAN countries: wide variation

Limited Practice

Temporary registration

Form of Mobility

Temporary Licensing/Registration in the ff:

1. Limited Practice

2. Expert Visit

3. Education / Training

4. Research

5. Humanitarian Missions

No need for licensure examinations

Trade in Services

Temporary

Short term

Does not involve:

Permanent registration

Acquisition of citizenship

Permanent employment

Differences in Form of Mobility

Engineering

Architecture

Accountancy

*ASEAN Registry

Dentistry

Medicine

Nursing

Options

ASEAN HEALTHCARE

PROFESSIONALS

COMPETE COMPLEMENT

COUNTRY

Number of

Accredited

Hospitals

First Hospital to Attain Accreditation /

Date attained

1. Thailand 18 Bumrungrad International: 2 Feb 2002

2. Philippines 5 St. Lukes Medical Center: 22 Nov 2003

3. Singapore 14 National University Hosp: 1 Aug 2004

4. Indonesia 5 Siloam Hospital Lippo Village: 19 Sept 2007

5. Malaysia 7 Penang Adventist Hospital: 16 Nov 2007

COUNTRY

Number of

Accredited

Hospitals

International Business and Trade

(In US dollars)

1. Thailand 18 1.3B

2. Singapore 14 750M

3. Malaysia 7

4. Indonesia 5

5. Philippines 5 250M

Cooperative Ventures to Achieve

Economic Pillars

ASEAN Cooperative Frameworks on Investments and Services

a. ASEAN Industrial Cooperation Scheme (AICO)

b. ASEAN Framework Agreement on Services (AFAS)

c. ASEAN Agreement on Movement of Natural Persons (AAMNP)

d. ASEAN Comprehensive Investment Agreement (ACIA)

Potential Cooperative ASEAN

Ventures under ACIA1. Food production

2. Energy

3. Oil production/development

4. Deuterium fuel production

5. ASEAN shipping and cruise lines

6. ASEAN railways

7. ASEAN air transport

8. Capital intensive projects

9. Space mission projects (for weather)

Potential Cooperative ASEAN

Ventures under ACIA

10. Tourism projects

11. Tertiary hospitals

12. SME support facilities

13. ASEAN industrial estates

14. Agribusiness

15. Insurance

16. ASEAN stocks

17. Research and training centers

18. ASEAN or Thai Canal

ASEAN Ventures

Free Flow of Investments

Building of Tertiary Hospitals, Research and Training Centers by foreign multinational companies

(Mode 3: Commercial presence)

Bringing of CEO’s / intracorporate transfers of key personnel (Mode 4: Movement of natural persons)

Future Healthcare Institutions

Operating Room Setting:

TEAM COMPOSITION: Multinational

Singaporean Surgeon

Thai Anesthesiologist

Indonesian Surgical Resident (Assist)

Filipino / Cambodian Nurses

Competition

1. Professionals: at level of Specialists

2. Investments

OPTIONS

COMPETE COMPLEMENT

SPECIALIZATION:

Most Important Issues

1. What is the present situation?

2. Which body regulates residency training? In the

ASEAN MRA, which is/are the PMRA?

3. Which body confers recognition of specialty

societies and specialty boards?

Recognition to training institutions? Recognition

of certificates as Diplomates and Fellows?

4. How will the present situation affect

competitiveness of specialists?

Issue No. 1

1. What is the nature of residency training

and specialization?

Issue No. 2

2. Which body regulates residency training?

In the ASEAN MRA, which is/are the

Professional Medical Regulatory

Authority?

ASEAN MRA

Article II. Professional Medical Regulatory

Authority (PMRA)

“refers to a body vested with the authority by

the government in each ASEAN Member

State to regulate and control Medical

Practitioners and their practice of

medicine”

PMRA’s: ASEAN Countries

COUNTRY Professional Medical Regulatory Authority

1. Brunei Darussalam Brunei Medical Board

2. Cambodia Cambodian Medical Council and Ministry of Health

3. Indonesia Indonesian Medical Council and Ministry of Health

4. Lao PDR Ministry of Health

5. Malaysia Malaysian Medical Council

6. Myanmar Myanmar Medical Council and Ministry of Health

7. Philippines Professional Regulation Commission

Professional Regulatory Board of Medicine

8. Singapore Singapore Medical Council

Specialists Accreditation Board

9. Thailand Thailand Medical Council and Ministry of Public

Health

10. Vietnam Ministry of Health

Recognition

ASEAN MRA requirements (2010)

Submission of:

1. Basic Qualifications and List of

recognized institutions

2. Postgraduate Qualifications and List of

recognized institutions

3. Core competencies and scope of

practice

Step 1. Situational Analysis

Undergraduate Medical

Education

Medical Schools: 38

Graduates: 4500

Takers PLE: 4000

Passers PLE: 2500

Passing: 62.9%

Poorly performing

medical schools: 17/38

Regulatory body: CHED

Postgraduate Medical

Education

Training Institutions

Graduates

Takers Certifying Exam

Passers

Passing

Poorly performing training

institutions

Regulatory Body: None

Specialties

Number of training programs

Passing percentage in

certifying examinations

General Surgery: 68 47.8%

Internal Medicine: 94 55%

Obstetrics-Gynecology: 93 60%

Pediatrics: 103 67%

Family Medicine: 46 53%

Pathology 44 40.70%

Needs of Professionals

PAFP Fellow

Applied for registration with Irish Medical Council (IMC)

IMC inquired from PRC whether the PAFP is a government-authorized body to conduct residency training in Family Medicine

Specialty certificate came from a private organization

ASEAN MRA Meeting

President of the Thailand Medical Council

Query: “why is it that Filipino specialists going to other countries carry with them certificates from private organizations only, and nothing coming from a government regulatory body”

9 other ASEAN countries: Medical Board, Medical Council, Ministry of Health

Singapore: Specialists Accreditation Board

Major Needs

1. To comply with requirements of an international agreement (ASEAN MRA)

2. To identify the regulatory body for postgraduate medical education (specialization)

3. To confer government recognition to training providers / institutions

4. To confer government recognition to specialists

5. To comply with the requirements of Executive Order No. 83 (PQF)

SONA

2011His Excellency Benigno S. Aquino III,

President of the Republic of the

Philippines, signed the

Executive Order No. 83 dated

October 1, 2012

INSTITUTIONALIZATION

OF THE

PHILIPPINE

QUALIFICATIONS

FRAMEWORK

Key Objectives

1. Establishes national standards and

levels for outcomes of education and

training, specializations, skills and

competencies

2. Provides national regulatory and quality

assurance arrangements for education

and training

IRR Rule II. Coverage

5.1 All sectors, levels, and modes of delivery of the Philippines’ trifocalized education system: basic education, technical vocational education and training, and higher education

5.2 All institutions and systems which provide trainings, specializations, skills and competencies, professional experience or through lifelong learning

8-LEVEL QUALIFICATIONS

DESCRIPTORS

Defined in terms of 3 domains

1. Knowledge, skills and values

2. Application

3. Degree of independence

THE PHL QUALIFICATIONS FRAMEWORK

LEVEL

GRADE 10

GRADE 12

TECHNICAL EDUCATION AND

SKILLS DEVELOPMENTHIGHER EDUCATION

DOCTORAL AND

POST DOCTORAL

BACCALAUREATE

BASIC EDUCATION

L1

L2

L3

L4

L5

L6

L7

L8

NC I

NC II

NC IV

NC III

NC IV

DIPLOMA

BACCALAUREATE

POST BACCALAUREATE

INDONESIA

S2

S1

S3

General High School

1

2

3

4

5

7

8

9

6

Professional

Spesialist

D I

D IV

D III

D II

Vocational Senior High School

Subspesialist

Elementary/Junior High School

FORMAL ACADEMIC EDU FORMAL VOCATIOAL/PROF EDU

MALAYSIA

Main Weaknesses

1. Proliferation of “specialists”

2. Classification of Physicians

3. Quality Assurance

Residency training

Accredited training

programsNon-accredited

training programs

Graduate

Certified

Did not graduate

Did not take exams

Did not pass

“Specialists”

GP with training

Board eligible

Specialists

Form own

organizations

Classification of Physicians

PRBOM PHIC PMA

GP GP GP

Specialist GP with training Board-eligible

Subspecialist Specialist Specialist

Subspecialist

Quality Assurance (Training

Programs)

Standards will have to be set for:

1. Accreditation of training providers

2. Institutional passing percentages

Actions and sanctions to include

Awards and commendations

Phase-out of poorly performing providers

Role of PRC and PRBOM

Consultative meetings with specialty

societies and boards (April, 2013)

Consensus on Oversight Function

No direct role in the operations or

implementation of training curricula

Setting of policies, standards together with

specialties

Role of Specialty Societies

Levels of Regulation

1. Self-regulation

2. Institution / Specialty Society

3. Government

Government Recognition

Government regulatory body confers

recognition to education and training

providers

PRC

PRBOM

Specialty

Societies

Specialty

Boards

Training

Providers

Developers of

Qualifications

Assessors of

Competencies

Certifying

Bodies

Accrediting

Bodies

Certification of Graduates

Training providers are responsible and

accountable for the implementation of

quality assurance mechanisms

Accreditation bodies are responsible for

quality audit and review

Recognition of qualification is based on

assessment of competencies attained by

the individual graduate

Competency Certification

Training institutions will assess

residents/graduates and will certify only

the competencies attained depending on

adequate operative experience

Review by Accreditation Committee and

Specialty Board

(Implications on privileging in practice)

Certificate as Diplomate/Fellow

The certificate (Diplomate/Fellow)

Who issues certificate?

Formal communication to PRC

Chairperson for inclusion of her signature

in certificates (PCS and PSA)

Dentistry Specialist Certificate

IS THE HEALTHCARE SECTOR READY

FOR ASEAN INTEGRATION 2015?

INSTITUTIONS

PROFESSIONALS

Summary

ASEAN Integration 2015

ASEAN MRA

Modes of supply of services

Form of Mobility

Specialization Issues

Impact on Competitiveness

CONGRATULATIONS TO THE PCCP!

THANK YOU

FOR YOUR KIND ATTENTION!

email: jcuetomd@gmail.com