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

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Malaysia and Indonesia, and has advertised throughout the region, targeting markets such as China and Vietnam. 41 Intra-ASEAN travel by these growing populations of medical travelers has been facilitated by increased capacity in interregional air transportation, and may benefit in the future from more efficient visa procedures. In 2005, the ASEAN transport ministers initiated a plan—the ASEAN Open Skies agreement—to accelerate the liberalization of air travel. This agreement allowed regional budget airlines to enter the market and offer more flights between ASEAN destinations, such as Kuala Lumpur and Singapore or Kuala Lumpur and Rangoon (Burma). 42 Additionally, one of the initiatives set forth in the Roadmap specified reduced visa requirements to simplify the cross-border movement of patients within the ASEAN region, 43 although it is unclear if advances have been made on this issue. By providing the organizational framework (through the AFAS) for regional cooperation and liberalization, ASEAN appears to have made progress in facilitating both increases in overall healthcare investment and further regional integration. Historically, governments have tended to maintain barriers to foreign healthcare establishments because they are often perceived as infringing on national sovereignty. 44 However, the seventh package of commitments in services in the AFAS, which was implemented in 2009, substantially liberalized commercial presence restrictions, largely removing equity limitations. 45 For instance, some countries such as Indonesia have liberalized regulations to permit foreign firms to hold majority shares; in Indonesia, foreign equity up to 51 percent is permitted. Vietnam also liberalized its regulations to allow 100 percent foreign ownership, although there is a minimum capital requirement of $20 million for hospitals. 46 Given the relatively recent implementation of these commitments, it is likely that the full impact of the rule changes on regional investment flows have not yet been captured in ASEAN member data. In addition, member governments have begun efforts to support this process by participating in bilateral agreements on healthcare to encourage regional trade and investment. For example, Brunei signed memorandums of understanding (MOUs) 47 on healthcare training and healthcare services with Singapore in 2004 and 2007, respectively, and a MOU on healthcare services with Thailand in 2010. 48 Singapore also 41 See the discussion on investment below for further information on regional expansion of healthcare providers. KPJ Healthcare Berhad Web site, “Hospital Network”; World Eye Reports, “Healthcare Tourism on the Rise,” November 14–15, 2010. 42 Industry representative, interview by USITC staff, March 7, 2010; Xinhua News Agency, “Myanmar, Malaysian Airlines Increase Flight Capacity,” October 6, 2005; Airline Industry Information, “Tiger Airways Increases Capacity on Singapore-Kuala Lumpur Route,” September 29, 2008; ASEAN Secretariat, “Eleventh ASEAN Transport Ministers Meeting,” November 17, 2005. 43 ASEAN Secretariat, “Appendix 1,” n.d. 44 Arunondchai and Fink, “Trade in Health Services in the ASEAN Region,” 2007, 2. 45 Industry representative, interview by USITC staff, March 9, 2010. Acquisition of an existing firm, or a controlling interest, is reportedly the easiest way for healthcare firms to enter a market, as it requires less investment in infrastructure and leverages local knowledge of consumption patterns and culture. Industry representative, interview by USITC staff, Singapore, March 9, 2010. 46 ASEAN Framework Agreement on Services, 2007. 47 A memorandum of understanding (MOU) is a binding document that expresses mutual accord on an issue between two or more parties. “Memorandum of Understanding,” Business Dictionary.com, n.d. (accessed June 27, 2010). 48 Ministry of Health, Singapore, “MOU between Singapore and Brunei Ministries of Health to Promote Trainings,” December 6, 2004; Chee, “Medical Tourism in Malaysia,” 2007, 20. 6-10
has a healthcare MOU with Cambodia. 49 These MOUs are intended to increase the cooperation in healthcare services between the respective countries across a number of areas, including training, research, investment, and the spread of infectious diseases. Export Competitiveness Thailand, Singapore, and Malaysia are the ASEAN region’s leading exporters of healthcare services. In 2008, Thailand reported the largest volume of medical travelers among ASEAN member countries (table 6.3), 50 with the majority coming from outside the ASEAN region. Thailand’s largest export market is reported to be the Middle East, accounting for over half of its foreign patients, although it also receives patients from developed nations such as Japan and the United States (5 percent and 3 percent, respectively). 51 Neighboring Burma is reported to be Thailand’s largest source of patients in the ASEAN market, accounting for 5 percent of medical travelers. 52 In contrast, Malaysia and Singapore largely export healthcare services to ASEAN neighbors. TABLE 6.3 Healthcare services: Exports of healthcare services, by estimated numbers of foreign patients, 2004–08 Country 2004 2005 2006 2007 2008 Malaysia 174,189 232,161 296,687 341,288 374,063 Singapore 320,000 374,000 410,000 348,000 (b) Thailand 1,103,905 1,249,984 1,450,000 (a) (b) 1,300,000 Sources: Association of Private Hospitals Malaysia, cited in Malaysia-German Chamber of Commerce and Industry, Market Watch 2010 , 2010, 7; Hospitals.sg, "Singapore's Medical Tourism Figures Revealed by Health Minister," January 28, 2009; Yap, "Medical Tourism and Singapore," 2006/2007, 025; Tourism Authority of Thailand, "Thailand Projects Around 2 Million Visitors for Medical Services," n.d.; International Medical Travel Journal , "Thailand: Thailand to Boost Medical Tourism in 2010," January 20, 2010. Notes: Singapore and Thailand do not report annual statistics on the estimated number of foreign patients treated. Instead, estimates for Singapore in 2004 and 2005 are from Yap, "Medical Tourism in Singapore;" 2006 and 2007 are from the Health Minister, as reported by Hospitals.sg . Estimates for Thailand are from two reports, both citing Tourism Authority of Thailand estimates. Data are not available for Singapore and Thailand for the years 2008 and 2007, respectively. a Data are likely underestimated, as specific statistics are not provided. Available data cite over 1,450,000 foreign patients treated in Thailand in 2006. b Not available. 49 Noor, “Thailand Looks to Set Up Private Hospital Here,” March 30, 2010. 50 Neither ASEAN nor the individual governments of these countries collect comprehensive statistics or comparable statistics on the volume of medical travelers on a regular basis, so statistics are estimates. Data on the value of healthcare services exports are not widely available or consistent. Instead, data on volumes of foreign patients are presented. These data are not specific to the private healthcare sector; however, based on anecdotal evidence, it is assumed that the majority of services are provided by private facilities. Industry representative, interview with USITC staff, Singapore, March 8, 2010; Hospitals.sg, “Singapore’s Medical Tourism Figures Revealed by Health Minister,” January 28, 2009. 51 International Medical Tourism Journal, “Thailand: Health and Medical Tourism Update,” April 15, 2010; industry representative, interview with USITC staff, Bangkok, Thailand, March 16, 2010; UN, ESCAP, “Medical Travel in Asia and the Pacific,” 2009, 16. 52 International Medical Tourism Journal, “Thailand: Health and Medical Tourism Update,” April 15, 2010. 6-11
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United States International Trade C
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U.S. International Trade Commission
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Abstract This report describes tren
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CONTENTS―Continued Chapter 5 Wood
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CONTENTS―Continued Tables—Conti
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Acronyms 3PL ACCSQ ACDD ACE ACIA AD
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LPI MDF MFN MOU MRA MTCC NAFTA NAP
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Executive Summary The Association o
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Infrastructure and the legal framew
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Despite tariff reductions, the regi
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CHAPTER 1 Introduction Purpose, Sco
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Participating countries also gain a
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TABLE 1.2 Export Competitiveness Fa
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transactions, reinvested earnings,
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Bibliography Acoca, Brigitte. Empow
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CHAPTER 2 ASEAN and Selected Region
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BOX 2.1 Timeline of important miles
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BOX 2.2 AEC Blueprint: Goals and me
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BOX 2.3 ASEAN-wide free trade agree
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progress has been only achieved in
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BOX 2.4 What is ATIGA? ATIGA builds
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TABLE 2.2 Intra-ASEAN imports and e
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TABLE 2.4 Total imports, exports, a
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China is often viewed as a major co
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cases of dispute, but does not prov
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TABLE 2.6 Minimum permitted equity
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TABLE 2.8 Ease of trading across bo
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it maximally useful, such as the ab
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TABLE 2.9 ASEAN in the World Bank
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foreign ownership of express delive
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population that regularly uses the
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Bibliography Acoca, Brigitte. Empow
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ASEAN Economic Ministers. “Joint
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Malaysian Institute of Economic Res
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CHAPTER 3 Electronics: Computer Com
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competition between ASEAN countries
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Regional Integration, Export Compet
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Supporting industries Another impor
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The AEF is unique within the region
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TABLE 3.3 Computer components: ASEA
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joint R&D. 71 These advantages of l
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order to compete for investment (bo
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efficient service to tenants. Despi
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Bibliography Asian Productivity Org
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World Trade Organization (WTO). Inf
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Project to stimulate intra-ASEAN pr
Page 96 and 97: TABLE 4.2 Certain cotton woven fabr
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Page 100 and 101: BOX 4.1 Cotton woven apparel: Profi
Page 102 and 103: national government source stated t
Page 104 and 105: strengthen supplier relationships.
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Page 108 and 109: investment, 67 with much of the inv
Page 110 and 111: Bibliography Association of Southea
Page 113 and 114: CHAPTER 5 Wood-based Products: Hard
Page 115 and 116: some cases, on the export of sawnwo
Page 117 and 118: TABLE 5.1 Hardwood plywood and floo
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Page 121 and 122: important factors continue to hampe
Page 123 and 124: TABLE 5.3 Major intergovernmental p
Page 125 and 126: Export Competitiveness In 2008, ASE
Page 127 and 128: TABLE 5.6 Hardwood plywood and floo
Page 129 and 130: FDI in hardwood plywood and floorin
Page 131 and 132: Trade across land routes has been a
Page 133 and 134: Azarcon, Chulia J. “Comparative T
Page 135 and 136: Malaysia Timber Industry Board (MTI
Page 137 and 138: CHAPTER 6 Healthcare: Healthcare Se
Page 139 and 140: In recent years, the traditional in
Page 141 and 142: services industry by developing the
Page 143 and 144: Only a few countries export large v
Page 145: growing populations, and increasing
Page 149 and 150: BOX 6.1 Healthcare services: Profil
Page 151 and 152: competition for foreign patients in
Page 153 and 154: Singaporean provider provides train
Page 155 and 156: Giusti, Daniele, Bart Criel, and Xa
Page 157: Socio-economic and Environmental Re
Page 160 and 161: Within the broad priority sector, t
Page 162 and 163: Japanese automakers. Their supplier
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Page 166 and 167: BOX 7.2 Automotive: Profile of ASEA
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Page 170 and 171: Despite the continued implementatio
Page 172 and 173: TABLE 7.2 Certain motor vehicle par
Page 174 and 175: Inbound Investment The investment e
Page 176 and 177: Trade Facilitation The timely movem
Page 178 and 179: Bibliography Aldaba, Rafaelita M.
Page 180 and 181: Thailand in the 2000’s. “Indust
Page 182 and 183: (2) the development of ASEAN cooper
Page 184 and 185: productive in climates further from
Page 186 and 187: ASEAN members Thailand and the Phil
Page 188 and 189: Tariff, import tariffs on palm oil
Page 190 and 191: BOX 8.1 Palm oil: Profile of ASEAN
Page 192 and 193: chain, from plantations to retailer
Page 194 and 195: TABLE 8.6 Palm oil: Intra-ASEAN inv
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Brunei Burma Cambodia Indonesia Lao
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Hickman, Martin. “Online Protest
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APPENDIX A USTR Request Letter
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A-4
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E Federal Register /Vol. 74, No. 23
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APPENDIX C Calendar of Hearing Part
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APPENDIX D Positions of Interested
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Mr. Aquino noted that the Philippin
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FTA (AANZFTA), Australian and New Z
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cumbersome rules of origin, customs
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APPENDIX E Country Profiles
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BURMA ECONOMIC PROFILE Economic Ind
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INDONESIA ECONOMIC PROFILE Economic
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MALAYSIA ECONOMIC PROFILE Economic
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SINGAPORE ECONOMIC PROFILE Economic
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VIETNAM ECONOMIC PROFILE Economic I
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TABLE F.1 Agro-based products: Prio
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TABLE F.3 Electronics: Priority sec
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TABLE F.4 Healthcare: Priority sect
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TABLE F.5 Textiles and apparel: Pri
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