Pen Point 37

Trade in health services, especially the migration of healthcare professionals (HCPs), is continuously growing.  As such, developing countries such as the Philippines, export healthcare professionals to other countries (mostly developed countries). The liberalization of trade in health services, espoused by the ASEAN Integration, has further promoted this migration of health professionals. Since the “world price” of nurses is higher than the “local price”, the Philippines has a comparative advantage in producing nurses, and gains by producing and exporting more. Obviously, one of the favorable effects of nurse migration is the considerable remittances sent home by theses nurses each year. Unfortunately, these remittances will not be able to offset the loss of skilled nurses due to migration, leaving behind an already disadvantaged health system.

The migration of HCPs has the potential to create an imbalance in supply and demand of health workforce in both the home and destination countries. The mushrooming of nursing schools in the Philippines, however, has relieved concerns on potential domestic shortage of nurses due to exportation. Another negative effect that the Philippines experience is the loss of educational expenditure. When government-subsidized nurses migrate to another country, the PH do not only lose a HCP but also the money invested in their education.


How do we balance competing interests in overseas health professionals’ remittances and the need for qualified health workforce in our weak health system extremely affected by the uneven distribution of health workers? Do we cast our nurses as “global goods” rather than “domestic providers” of health care, implicating them as sources of remittance income rather than for their potential contributions to the local health system?

Does this kind of trade in health care promote the realization of self-interest or social interest? Who really gains and loses from this trade? Do the losses, if any, exceed the gains? Is this kind of trade not only motivated by the desire for revenue, but also by the desire to cope with overproduction and lack of opportunities for nurses in the Philippines?

Pen Point 36

Given adequate information, the market theory assumes that consumers know what is best for themselves; hence, they make choices that maximize their total satisfaction. If this assumption is wrong, markets may not efficiently produce. We call this satisfaction consumers gain from consuming a good or service as “utility”. The satisfaction (or utility) depends on the quantity and mix of goods and services chosen by a consumer. The theory holds that consumers get more satisfaction from more goods and services but the increase in satisfaction from consuming additional units gradually diminishes. In health care, how do consumers go about choosing the mix of goods and services which give them the maximum total utility? In places where there are few sources of health care goods and services, do people take into account their tastes/preferences and income when choosing a combination of goods and services which gives the people the highest utility? Do people’s preferences and tastes change in situations where there are very few choices? Or do they develop an acquired taste/preference because of limitations posed by societal inequities?

Pen Point 35

Issues with equity have influenced health care for many years. Equity, in the context of social health insurance such as the Philippines’ Philhealth, means access of the whole population to a package of health services by paying an affordable contribution, and sometimes no contribution at all (for senior citizens and indigents). Philhealth can improve access to health care for some groups and could potentially increase resources for health care.

The increase in demand for health care of those covered by Philhealth may require an efficient allocation of scarce resources, such as medical staff, medicines, as well as hospital beds. Philhealth’s commitment to ensure access to health care services must be coupled with the government’s commitment to an acceptable level of supply.

Does the current national social health insurance program increase or decrease the efficiency of the use of scarce resources? Is ‘access’ rather than ‘utilization’ of health services a better measure of equity in health care?