Saturday, May 19, 2012

Health Transparency 6: Physician Protectionism

Nearly 3 years ago, I wrote this:

Physician Protectionism

July 24, 2009

My clubmate in Rotary, a board member of MG Thinkers and a physician friend, Dr. Jed Inciong, wrote about a certain bill in Congress that imposes what can be considered as "physician protectionism".

Jed said that certain elitist specialty societies and medical practioners who belong to private associations affiliated with the Philippine Medical Association (PMA), are now moving to corner the practice of specific aspects of medical practice in pushing for the Medical Integration Bill, House Bill 5575. Jed added,
In the guise of moving into self-regulation of the practice of medicine, the PMA follows meekly in the dictates of the specialty societies. What the House Bill actually aims for is to limit specialty practice to only those that these specialty societies approve. But the reality is these PMA affiliates are not the only "umbrella organization" of specific medical specialty practice. An example would be that there are 2 or 3 more umbrella organizations for the practitioners of dermatology not belonging to the derma society which is affiliated with the PMA.
If this bill becomes law, it shall discriminate against the vast majority of physicians practicing outside the major metropolitan Philippine cities. Even more so, it shall compromise the practice of the majority of physicians employed in government hospitals outside these same Metro areas.

It was the first time I've heard of this issue, I thanked Jed.

Protectionism -- only us, no competition -- by so many professions in the country is institutionalized in the Constitution itself: engineers, architects, lawyers, physicians, nurses, accountants, etc. are reserved only for Filipinos. Filipino doctors and nurses can practice almost anywhere in the world but foreign doctors and nurses cannot practice here! Talk about hypocrisy and double standard.

Now among Filipino physicians, there is this physician protectionism proposal in Congress. It never fails. People who have some protectionist, even evil, plans always run to the State.

In a free market environment, patients and the public have the freedom to choose who are the doctors and health professionals who can treat them. This pressures the health professionals and establishments (hospitals, clinics, HMOs, etc.) to have good professional reputation and good corporate integrity. They may be expensive but there is good quality of service attached to their names and patients hold on to that image.

No government coercion needed here, by forcing patients to seek treatment only to physicians affiliated with a particular medical association or society. And physicians outside of that medical association will be penalized with "non-accreditation" and hence, will get somehow a negative image from the patients, even if those physicians have good professional record.

I think this bill did not  become a law, thanks.  Last week, a discussion with some friends in facebook about "open sky" policy and airline reciprocity moved to a discussion on reciprocity in the practice by professionals from other countries. Here's our brief exchange on the subject:

Nonoy: When Filipino doctors, nurses, engineers are allowed to work as doctors, nurses and engineers in the US, UK, Canada, etc., those countries did not ask for "reciprocity", that American, British, Canadian, etc. doctors, nurses and engineers should also be able to work here. They are banned from practicing here, Constitutional ban.

Steve: Nonoy, thanks for raising the issue of the closed doors of the Philippines to any non-citizens receiving licenses to practice, although our citizens can and do freely practice in many other nations, as long as they pass the test and pay the licensing fee. I think registered dietitions (or nutritionists) are the only ones allowed reciprocity and that only with the US.

Nonoy: Discussion of reciprocity, I think an "innocent" but hypocritical concept. "I open thiis so long as you open that too." So if one or both won't open, or just open up a bit, then both parties or both governments will be closing opportunities for their people. It's good that the US, UK, etc. are more open minded with regards to mobility of people, they allow Fil doctors, nurses, engineers, dentists, etc. to practice in their countries, did not ask for reciprocity from some slightly xenophobic governments like the Philippines.

Steve: I don't know the policies of openness in licensed professions for Japan and Korea, but the US and UK certainly allow any competent person to practice, regardless of citizenship. Perhaps a case could be made for that infusion of talent and "mind-power" adding to the power of the economy?

Nonoy: I think even the leaders of the local professional organizations (PMA for physicians, PNA for nurses, UAP for architects, IBP for lawyers, etc.) who probably lobbied for that provision in the constitution to ban foreign professionals from practicing in the country know the arrogance and hypocrisy of their position. They did not even cite "reciprocity", they simply wanted an outright ban and prohibition of foreign professionals.

All economic growth of any country mainly comes from one important resource: people, their brains and muscle. That is why big population countries usually have large economies -- more entrepreneurs, more workers, more professionals, more consumers. But some small population countries have big economies too, because of the entry of more brains, including foreign brains and muscle, into their country. LIke HK, Sing, Netherlands, etc.

I hope that should a constitutional change become a reality someday, not only the 60-40 restrictions on foreign equity be removed, ie, foreigners can own 100 percent equity in more sectors and industries in the country, but also the restrictions on the practice of foreign professionals here will also be lifted. Especially for health professionals like physicians, dentists, nurses, med techs, pharmacists, and so on.

See also:
Health Transparency 1: MeTA Forum January 2009, January 26, 2009
Health Transparency 2: CHAT Discussion and Debates, June 15, 2009
Health Transparency 3: MeTA Forum January 2010 (Prevention vs. Medication), January 27, 2010
Health Transparency 4: Drug Promotions and Government, September 03, 2010
Health Transparency 5: Forum on Good Governance in Health, March 08, 2012


LEONIE O. said...

Hi Nonoy,

Reciprocity is provided is the Pharmacy Bill now pending in both Senate and Congress to be passed and hopefully become the law that will replace R.A.5921. I personally do not have anything against having foreign professionals practice here as long as clear guidelines relative to this is set. Also they could actually serve as a challenge to the Filipino professionals to remain and continue to be competitive so he will not be overtaken. In fact this if allowed,could also be a venue for learning through sharing of expertise.

Anonymous said...

I have always heard the concern for reciprocity, and that health professional groups are very fearful of competition. Reciprocity principle sometimes become barriers to trade and providing access to healthcare.