ASEAN: Regional Trends in Economic Integration, Export ... - USITC

services industry by developing the Roadmap to coordinate country efforts, establishing
the ASEAN Framework Agreement on Services (AFAS) to secure commitments on
healthcare services, and initiating the effort to harmonize licensing standards and
qualifications for healthcare services workers across countries.
Background
Private sector 21 participation across all ASEAN healthcare markets has increased in
recent years, although healthcare systems in the region vary in terms of their privatepublic
mix (table 6.1). 22 In Brunei, Malaysia, the Philippines, and Thailand—the largest
healthcare markets in the ASEAN region as measured by per capita healthcare
expenditure—the private healthcare sector plays a larger role; for example, in Singapore,
7 of its 13 hospitals are private facilities. 23 Vietnam, which opened its healthcare market
to private facilities in 2003, had 20 private hospitals in 2008, two of which were foreignowned.
24 In contrast, Burma and Laos only recently opened their markets to private
providers, and so continue to have largely public healthcare systems. 25 Healthcare
systems in Cambodia and Indonesia are in transition as well. Both of these countries, due
either to lack of infrastructure or to patient preference, meet excess demand by importing
significant volumes of healthcare services from the more developed markets in the
region. 26
21 The focus of this analysis is the private healthcare services sector, as publicly provided services are a
public good and generally do not compete with private services.
22 Governments frequently participate in the provision of healthcare services to address economic and
public health concerns, often serving as the primary healthcare provider in lower-income economies.
However, as countries experience economic development, the private healthcare system develops and treats
public health issues. Additionally, the population’s preference for healthcare services shifts, due to the
increased incidence of noncommunicable diseases as well as rising household expenditure on health. As a
result, healthcare systems frequently grow over time to include a mixture of public and private providers as
governments seek private sector participation to further develop healthcare infrastructure and meet growing
demand. Arunanondchai and Fink, “Trade in Health Services in the ASEAN Region,” 2007, 2, 8; Hanson and
Berman, “Private Health Care Provision in Developing Countries,” n.d., 10; Global Health Council, “Private-
Public Sector,” n.d.
23 Ministry of Health Singapore, “Healthcare Facilities,” n.d.; Ministry of Health Singapore, Health Facts
2008, 2008.
24 International Medical Travel Journal Online, “Indochina,” November 20, 2008.
25 In Burma, private hospitals were prohibited prior to 2007, and in Laos, the government granted the first
licenses for private hospitals in 2009. Irrawaddy, “Burma Licenses Private Hospitals, Clinics,” October 8,
2009; Phouthonesy, “Govt Grants First Private Hospital Licenses,” September 22, 2009.
26 Imports of healthcare services refer to the movements of individuals across borders to receive medical
treatment and care outside their home market.
6-5