RUMAH SAKIT KHUSUS

DAN
PERSIAPAN MENGHADAPI PASAR
BEBAS ASEAN 2015

BIMBINGAN TEKNIS RUMAH SAKIT KHUSUS

Jakarta, 12-14 September 2012

Agung P. Sutiyoso
TIM BIDANG JASA DAN PRODUK KESEHATAN
KEMKES
Sub Kelompok Kerja Dokter Dan Dokter Gigi
 ACHIEVEMENT OF THE AFAS 2015 TARGETS
9th Package 10th Package
Completion Target AEM 2013 AEM 2015
Number of Subsectors 104 128
Mode 1 All 104: None All 128: None
Mode 2 All 104: None All 128: None
29 PIS: 70% 29 PIS: 70%
Mode 3MA FE 9 LOG: 70% 9 LOG: 70%
66 OTHER: 51% 90 OTHER: 70%
29 PIS: No limitation 29 PIS: No limitation
9 LOG: No limitation 9 LOG: No limitation
Mode 3 MA Limitations
26 OTHER: max 2 lim
90 OTHER: No limitation
26 OTHER: max 1 lim
Max 3 lim /subsector (including Max 1 lim /subsector
Mode 3 NT
horizontal) (including horizontal)
Mode 4 To be agreed To be agreed
15%*(104*3)= 47 modes 15%*(128*3)= 58 modes
Flexibility Allowed
across modes 1-2-3 across modes 1-2-3
Max flexibility
55%*47= 26 modes 50%*58= 29 modes
in one mode of supply
 WTO ( GATT GATS - TRIPS ) PURPOSE

GLOBALISATION
Openness

Rules &
Institutions

Cross-border
flows

Population-level Health-related World Health Care

Health Influences Factors Markets System
Agung 06-11
 Health Services System

Regulations Inputs/costs

Organisation
financing
Clinical Services

delivery

Health
Health service
Health
service service
QUALITY
Access Price
SAFETY
Agung 06-11
 Specific Commitments
Sector - Subsector

Business
Telecommunication
Construction
Distribution
Environment
Finance
Education
Health & Social services
Culture & sport
Tourism/Courier

Cross-industrial commitment
Market access

Transportation
Others

1
2
National treatment

3
4
1
2
3
4

4:
3:
2:
1:
GATS /AFAS - Scope of analysis -

CP
CB
CA

Agung 06-11
1-4 modes

MNP
 INDIA REQUEST
I. BUSINESS SERVICE
A. Professional Services
Modes of supply
(1) Cross - border supply (2) Consumption Abroad (3) Commercial Presence (4) Presence of Natural Persons

Sector or sub- Limitations On Additional

sector
Limitations on Market Acces National Commitments
Treatment
8.A.i. 1) None 1) None
Hospital 2) None 2) None
Services
3) None through removal of JV requirements contained in 3) None
(CPC 9311)
horizontal commitments.
4) None in rescpect of Medical and Dental services: i.e. 4) None
Medical Doctors, Dentists, Health Professionals not
elsewhere classified; Medical Assistants, Sanitarians,
Dieticians and Nutritionist, Optometrists and Opticians, Dental
Assistants, Modern Health Associate Professionals not
elsewhere classified;
Services provided by Midwives, nurses, physictherapists and
paramedical personnel, Pharmacist, Nursing & Midwifery
Professionals. Physiotherapists & Related Associate
Professionals, Pharmaceutical Assistant, Nursing Associate
Professionals, Midwifery Assosiate Professionals.
Extent of Commitment
None or Full- Commitment to provide full market access and/or national treatment for a particular mode (no restrictions)
Partial Commitment- provide market access and/or national treatment, with restrictions listed
Unbound- No commitment at all on market access and/or national treatment for a particular mode Agung 06-11
 Limitations in Services Trade
Market Access National Treatment
Foreign service
suppliers are granted treatment no less
Number of Supplier favorable than that accorded to
Value of Transaction national service suppliers
Number of Operations
Number of Natural Tax Measures
Persons Nationality
Type of Legal Entity Requirement
Participation of Foreign Residency Requirement
Capital Licensing, Standards
Other Measures and Qualifications
Registration
Requirement
Laws and regulations that are Authorization
more burdensome Requirement
than necessary to ensure Ownership of Property
the quality of a service
can be challenged as barriers of Property/Land
to trade Other Measures
Agung 06-11
 SECTORS-SUBSECTORS :
CENTRAL PRODUCT CLASSIFICATION ( CPC)

(1.) Bussiness Services :

A. Professional Services :
h. Medical and dental services (CPC 9312)
CPC 93121: General medical services
CPC 93122: Specializes medical services
CPC 93123: Dental Services
j. Services provided by midwives, nurses, physiotherapy and
Para-medical personnel (CPC 93191)

(8.) Health Related Social Services ( other than those listed under 1.A.h-j)
A. Hospital Services (CPC 9311)
B. Other human health services(CPC 9319 excluding 93191)
CPC 93192 : Ambulance Services
CPC 93193 : Residential health facilities services other than
hospital Services
C. Social Services :
CPC 93311 : Welfare services for elderly and handicapped
CPC 93319 : Other social services with accomodation
CPC 93321 : Child day-careservices
Etc
Agung 06-11
 Market-Orientated Health Care
In market-orientated medical care, the patient is the
customer and the medical care and service rendered by the
doctor and hospital is the commodity and service traded in a
demand and supply chain
As a user and client, the patients main desire is
to secure the best doctor,
the best medicine,
the best hospital facilities and
the best attended and related personal care services.
( Quality - Safety)
And the patient hopes to purchase all these at the lowest possible
medical cost.
3 Players: 3 Markets:
the Patient/Citizen, the Service,
the Health Care Provider, and the Expert, and
the Health Care Purchaser. the Purchaser Markets.
Agung 06-11
 Hospital Values Chain .
M Poter

Clinical services
Pelayanan
Aktifitas

Pra Proses Pelayanan: Pasca

Pelayanan: Pelayanan:
Proses Pelayanan
Klinik Follow-up

Budaya Organisasi Nilai yang

Aktifitas Penduukung

didapat
Asumsi Bersama, Nilai-nilai bersama
pasien
Struktur Organisasi
Fungsi, Divisi, Matriks
Sumber Daya Strategis
Keuangan, SDM, Informasi, Teknologi
Organized Medical Staff Section Governing Council presents

Quality and Clinical Culture:

The Critical Role of Physicians in Accountable
Health Care Organizations
Ms. Gosfields excellent paper makes the vital connection between physician involvement
in medical and CLINICAL decision-making and high quality patient care. She clearly
establishes that physician leadership is critical to halt the erosion of professionalism in our
volatile health care environment.
------E. Ratcliffe Anderson, Jr., MD, Executive Vice President, American Medical Association

"Gosfield's Quality and Clinical Culture provides a direct, clear and detailed linkage between the highly
valued, scientifically grounded caring physicians' role and the emerging accountable organizations that
are changing health care in this country. Her grasp of the core elements of the physician's clinical culture
goes beyond idealism and nostalgia to real understanding. Gosfield's command of the new demands of
accountable healthcare, its organizations, and its existence in the marketplace provide the grounding for
a new synthesis that recognizes the uniquely personal character of the clinical culture."
------John M. Ludden, MD, Senior Vice President for Medical Affairs, Harvard Pilgrim Health Care
 AFAS MRA ON MEDICAL PRACTITIONER
ARTICLE III
RECOGNITION, QUALIFICATIONS AND ELIGIBILITY
OF FOREIGN MEDICAL PRACTITIONERS

3.1 Recognition of a Foreign Medical Practitioner.

3.1.1 possession of a medical qualification recognized by the PMRA of the Country of Origin
and Host Country;

3.1.2 possession of a valid professional registration and current practising certificate

to practice medicine of the Country of issued by the PMRA Origin;

3.1.3 minimum practical experience of five (5) continuous years preceding the application
since after registration for General Medical Practitioners and/or minimum period of five (5)
continuous years after completion of specialist training and registered as a specialist
in the Country of Origin;

3.1.4 compliance with Continuing Professional Development (hereinafter referred to as

"CPD") at satisfactory level in accordance with the policy on CPO mandated by PMRA in
the Country of Origin;

3.1.5 certification from the PMRA in the Country of Origin of no record of having violated any
professional or ethical standards, local and international, for the practice of
medicine~.

Agung 06-11
Health worker density Global Discrepancy / Inequity
 Current Situation of Distribution
of Health Work Force (HWF)

Countries with most critical shortage are Bangladesh, Bhutan, India,

Indonesia, Myanmar, Cambodia and Nepal

Data Source : WHO

 RINGKASAN PANDANGAN TENTANG
RS KHUSUS DAN PERSIAPAN MENGHADAPI PASAR BEBAS ASEAN 2015

1. Free Trade ASEAN 2015 is trade with limited Market Access and no
National Treatment
2. Patient is the customer and medical service rendered by the doctor and
hospital is the commodity and service traded in :
a demand supply - price chain
3. Patients main desire as customer :
- Quality and Safety :
to secure the best doctor,
the best medicine and equipment,
the best accredited hospital and
the best attended and related personal care services.
- Cost patient hopes to purchase all these at the lowest
possible medical cost.
4. Preparation to cope with 2015 Asean Free Trade (AEC) is :
The ability for Special hospital to fulfill patients desire in global
competitiveness on services qualities, safety , access and cost