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The 25th CMAAO Congress and the 43rd Council Meeting

Hotel Royal Cliff Beach and Resort, Pattaya, ThailandNovember 18–20, 2007

The 25th CMAAO (Confederation of Medical Associations in Asia and Oceania) Congress and the 43rd Council Meeting was held from November 18 (Sun.) to 20, 2007 in Thailand.

This year’s congress was attended by some 50 representatives of 13 member NMAs. With the re-admittance of the Sri Lanka Medical Association officially decided, CMAAO now has a membership of 17 medical associations. This year’s congress considered plans for events celebrating the confederation’s 50th anniversary in 2008/2009 as well as invigoration of confederation activities. Decisions made concerning CMAAO operations included newly appointing a legal advisor to provide support for legal aspects of future confederation activities; revising the Constitution and Bylaws to renew and strengthen organization; and making efforts to recruit those NMAs that are members of Medical Association of South East Asian Nations (MASEAN), but not yet of CMAAO.

At the Opening Ceremony held on November 19, Professor Dr. Somsri Pausawasdi (Immediate Past President, The Medical Association of Thailand) was installed as the 28th President of the CMAAO (2007–2009) and presented with the CMAAO Presidential Medal by out-going President Dr. Jae Jung Kim of Korean Medical Association.

The Country report session was held on November 19 and the symposium was held on November 20 on the theme “Arts and Science of Longevity.”

Presentations at the symposium were delivered by 8 speakers from NMAs of Hong Kong, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan and Thailand.

Participants in the CMAAO Meeting in Thailand

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Program

DAY 1: Sunday, November 18, 2007

08:30 – 09:00 Grand Opening Ceremony

09:00 – 09:15 Installation of the President Elect of the CMAAO: Chaired by Dr. Wonchat Subhachaturas, Chair, CMAAO

09:15 – 10:00 The 8th Taro Takemi Memorial Oration “60 years of Thai Healthcare under H.M. King Bhumibol” 1. Opening and introduction of the speaker: Dr. Masami Ishii, Secretary General, CMAAO 2. Oration: Prof. Dr. Prinya Sakiyalaksana 3. Presentation of a commemorative plaque to the speaker: Dr. Jae Jung Kim, President, CMAAO

10:00 – 10:30 Coffee Break

10:30 – 12:00 Professor Boonsom Martin Honourary Lecture “Music Therapy” (in Thai)

12:00 – 13:00 Lunch

13:00 – 16:00 The 43rd CMAAO Council Meeting: Chaired by Dr. Wonchat Subhachaturas 1. Call to Order 2. Roll Call and confirmation of Councilors of CMAAO: Dr. Masami Ishii 3. Welcome Address: President of the MAT, Air Marshal Apichart Koysukhlo 4. Report of the Secretary General 5. Approval of Minutes of the 42nd CMAAO Mid-term Council Meeting held in Singapore (November, 2006) 6. Report of the Treasurer: Dr. Yee Shing Chan, Treasurer (1) Financial Statement for 2006–2007 (2) Budget for 2007–2009 7. Venue and Dates of the 44th CMAAO Mid-term Council Meeting (2008) 8. Venue and Dates of the 26th CMAAO Congress & 45th Council Meeting (2009) 9. Membership Applications 10. Other Business 10-1. Proposed amendment of the Constitution & By-laws submitted by the Singapore Medical Association 10-2. Others 11. Adjournment

18:30 – 21:00 Welcome Reception

DAY 2: Monday, November 19, 2007

09:00 – 10:30 The 25th CMAAO Congress and Assembly Opening Ceremony Chaired by Dr. Masami Ishii, Secretary General, CMAAO 1. Call to Order: Dr. Jae Jung Kim, President, CMAAO 2. Roll Call: Dr. Masami Ishii, Secretary General, CMAAO 3. Opening Remarks: Dr. Jae Jung Kim 4. Welcome Address: Lord Mayor of Pattaya Adm. 5. Installation of the 28th President of the CMAAO: Dr. Jae Jung Kim (Handover of the CMAAO Presidential Medal) Outgoing President, CMAAO 6. Inaugural Address: Professor Dr. Somsri Pausawasdi 7. Presidential Award to be presented to Dr. Kim by Professor Dr. Somsri Pausawasdi

10:45 – 12:00 The 25th CMAAO Congress and Assembly Meeting Chaired by Professor Dr. Somsri Pausawasdi 1. Approval of Minutes of the 24th CMAAO Congress held in Korea (September, 2005) 2. Report of the Council: Dr. Wonchat Subhachaturas

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3. Report of the Treasurer: Dr. Yee Shing Chan 3-1. Financial Statement for 2005–2007 3-2. Budget for 2007–2009 4. Membership Applications 4-1. Sri Lanka Medical Association 5. Appointment of Standing Committee Members on: 5-1. Constitution and By-laws: Chairperson and three Members 5-2. Nominations: Chairperson and two Members 5-3. Resolutions: Chairperson and three Members 5-4. Finance: Chairperson and two Members 6. WMA Report: Datuk Dr. N. Arumugam, Immidiate-past President, WMA12:00 – 13:30 Lunch hosted by the Medical Association of Thailand

13:30 – 15:00 The 25th CMAAO Congress and Assembly Meeting (cont.) 7. Reports of Activities of NMAs (Country Report)15:15 – 16:00 8. Future Meetings 8-1. The 44th CMAAO Mid-term Council Meeting (2008) (Venue and Dates to be confirmed) 8-2. The 26th CMAAO Congress & the 45th Council Meeting (Venue and Dates to be confirmed) 9. Other Business 9-1. Proposed amendment of the Constitution & By-laws by the Singapore Medical Association 9-2. Membership fee for the Sri Lanka Medical Association 9-3. Membership fee for the Nepal Medical Association 9-4. Increase of the membership fee of CMAAO 9-5. Proposal for collection of registration fee for the CMAAO Mid-term Council Meetings in the future 9-6. Establishment of the traveling fund in the CMAAO 9-7. Conversion of some of the CMAAO funds to Japanese yen 9-8. Any other business

17:00 – 21:30 The Thai Extravaganza Show

DAY 3: Tuesday, November 20, 2006

08:30 – 11:30 Symposium: “Arts and Science of Healthy Longevity”

11:30 – 12:00 The 25th CMAAO Congress and Assembly Meeting (cont.) 1. Report of the Committees for Approval 2. Election of the Officers of CMAAO: Dr. Masami Ishii 3. Closing Remarks: Professor Dr. Somsri Pausawasdi

14:00 – 17:00 City Tour

18:30 – 21:00 Farewell Dinner

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President:

Jae Jung Kim (Korea)

President-Elect:

Apichart Koysuklo (Thailand)

Immediate Past President:

Eitaka Tsuboi (Japan)

1st Vice President:

Pheng Soon Lee

2nd Vice President:

Somsri Pausawasdi

Chair of Council:

Wonchat Subhachaturas

Vice-Chair of Council:

Ross Boswell

Treasurer:

Yee Shing Chan

Secretary General:

Masami Ishii

Councillors:

Mukesh Haikerwal (Australia)

A.Z.M. Zahid Hossain (Bangladesh)

Sok Khonn Sau (Cambodia)

Yee Shing Chan (Hong Kong)

Ketan Desai (India)

Fachmi Idris (Indonesia)

Yoshihito Karasawa (Japan)

Dong Chun Shin (Korea)

Nai Chi Chan (Macau)

Siang Chin Teoh (Malaysia)

Sudha Sharma (Nepal)

Peter Foley (New Zealand)

Phoebe Lim-Catipon (Philippines)

Chiang Yin Wong (Singapore)

Ming-Been Lee (Taiwan)

Wonchat Subhachaturas (Thailand)

Advisor:

Tai Joon Moon (Korea)

Officers, Councillors, Secretary General and Advisors of CMAAO 2005–2007

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CMAAOThe Confederation of Medical Associations in Asia and Oceania

(Established since 1956)

Official Homepage http://www.cmaao.org/

Current membership: 17 national medical associations(As of November, 2007)

Australian Medical Association42 Macquarie Street Barton ACT 2600P.O. Box 6090, Kingston ACT 2604AustraliaTel: +61-2-6270-5400Fax: +61-2-6270-5499E-mail: [email protected]: http://www.ama.com.au

Bangladesh Medical AssociationBMA Bhaban 15/2 Topkhana RoadDhaka-1000, BangladeshTel: +88-02-9555522Fax: +88-02-9566060E-mail: [email protected]: http://www.bma.org.bd

Cambodian Medical AssociationCorner St. 278 Preah Monivong Blvd.P.O. Box 2432 Phnom Penh, CambodiaTel: +855-17522360E-mail: [email protected]

Hong Kong Medical Association5/F Duke of Windsor Social Service Building15 Hennessy Road, Hong KongTel: +852-2527-8285Fax: +852-2865-0943E-mail: [email protected]: http://www.hkma.org

Indian Medical AssociationI.M.A. House, Indraprastha MargNew Delhi-110 002, IndiaTel: +91-11-23370009, 23378819Fax: +91-11-23379470, 23379178E-mail: [email protected]: http://www.ima-india.org

Indonesian Medical AssociationJl. Dr. G.S.S.Y. Ratulangi No.29, Menteng Jakarta Pusat 10350, IndonesiaTel: +62-21-3900277, +62-21-3150679Fax: +62-21-3900473E-mail: [email protected]: http://www.idionline.org

Japan Medical Association (Secretariat)2-28-16 Honkomagome, Bunkyo-kuTokyo 113-8621, JapanTel: +81-3-3942-6489Fax: +81-3-3946-6295E-mail: [email protected]: http://www.med.or.jp/english

Korean Medical Association302-75 Ichon1-dong, Yongsan-guSeoul 140-721, KoreaTel: +82-2-794-2474 (ext. 120/121)Fax: +82-2-793-9190E-mail: [email protected]: http://www.kma.org

Macau Medical Association122, Ave do Rodrigo RodriguesEdif. Highfield Court, 2F, MacauTel: +853-388388Fax: +853-788789E-mail: [email protected]

Malaysian Medical Association4th Floor, Bangunan MMA 124 Jalan Pahang53000 Kuala Lumpur, MalaysiaTel: +603-40411375Fax: +603-40418187E-mail: [email protected]: http://www.mma.org.my

Nepal Medical AssociationNMA Building, Siddhi SadanP.O. Box 189, Exhibition Road Kathmandu, NepalTel: +977-1-4231825Fax: +977-1-4225300E-mail: [email protected]: http://www.nma.org.np

New Zealand Medical Association26 The Terrace P.O. Box 156Wellington, New ZealandTel: +64-4-472-4741Fax: +64-4-471-0838E-mail: [email protected]: http://www.nzma.org.nz

Philippine Medical Association2nd Floor PMA Administration BuildingNorth Avenue, Quezon CityMetro Manila, PhilippinesTel: +63-2-929-6366Fax: +63-2-929-6951E-mail: [email protected]: http://www.philippinemedicalassociation.org

Singapore Medical Association2 College RoadLevel 2 Alumni Medical Centre Singapore 169850, SingaporeTel: +65-6223-1264Fax: +65-6224-7827E-mail: [email protected]: http://www.sma.org.sg

Sri Lanka Medical AssociationWijerama House, No. 7Wijerama Road, Colombo 00700Sri LankaTel: +94-11-2693324Fax: +94-11-2698802E-mail: [email protected]: http:www.slma.lk

Taiwan Medical Association9F, No. 29, Sec. 1, An-Ho RoadTaipei, Taiwan, R.O.C.Tel: +886-2-2752-7286Fax: +886-2-2771-8392E-mail: [email protected]: http://www.tma.tw

The Medical Association of Thailand4th Floor, Royal Golden Jubilee Building, 2Soi Petchburi 47 (Soi Soon Vijai)New Petchburi Road, Huaykwang DistrictBangkok 10310, ThailandTel: +66-2-314-4333Fax: +66-2-314-6305E-mail: [email protected]: http://www.mat.or.th

Secretary General: Dr. Masami IshiiSecretariat: JAPAN MEDICAL ASSOCIATION 2-28-16 Honkomagome, Bunkyo-ku, Tokyo 113-8621, Japan Tel: +81-3-3946-2121 Fax: +81-3-3946-6295 E-mail: [email protected]

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HONG KONG MEDICAL ASSOCIATION

CHAN Yee-shing Alvin*1

*1 Council Member, Hong Kong Medical Association, Hong Kong ([email protected]).

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714 JMAJ, January /February 2008 — Vol. 51, No. 1

Chan YA


Chan YA


INDONESIAN MEDICAL ASSOCIATION

Ihsan OETAMA*1

*1 Chairman, International Relations, Indonesian Medical Association, Jakarta, Indonesia ([email protected]).

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Oetama I


JAPAN MEDICAL ASSOCIATION

Kazuo IWASA*1

*1 Vice-Chair of Council, World Medical Association. Vice-President, Japan Medical Association, Tokyo, Japan ([email protected]).

Grand Design 2007 Published by theJMA

The JMA recently published a policy analysisdocument titled “Grand Design 2007” based onthe discussions with the JMA Research Institutestudy group on the future of Japanese healthcare.This grand design lays the analytical foundationsfor state finances overall in order to give directionto the reconstruction of the health insurancesystem and discusses total analysis of nationalfinance to see how healthcare as the core of socialsecurity should be treated in the future. Based onthese two pillars, we are trying to evaluate thecurrent healthcare provision system to find mostappropriate way of how the environment toensure quality healthcare should be providedand discuss the most appropriate way of the costsharing by the Japanese people for healthcare. Ofthese, the general statement will be published inEnglish translation in the JMA Journal of theJapan Medical Association in installments, andwe encourage you to read it.

The 27th General Assembly of theJapan Medical Congress

The General Assembly of the Japan MedicalCongress met in Osaka in April 2007. Its themeswere “life, people, and dream,” and 25,000 peopleattended it. The General Assembly meets onceevery 4 years. Its first meeting was in 1902, andthis year was its 27th meeting. The GeneralAssembly now has a tradition of over 100 years.During the period of this General Assembly,the officers of the Korean Medical Associationin charge of scientific affairs visited Japan andconducted an exchange of opinions with JMAofficers including myself.

JMA Research Institute Celebrates 10thAnniversary

This year the JMA Research Institute, the JMAthink tank, celebrates the 10th anniversary ofits foundation, and an event was held in Aprilto mark the occasion. Dr. Michael Reich, TaroTakemi Professor of International Health at theHarvard School of Public Health, and Mr. KeizoTakemi, then Vice Minister of Health, Laborand Welfare, joined Dr. Yoshihito Karasawa,President of JMA for a panel discussion onhealthcare. People interested will also find thiscontent published in the JMA Journal.

WMA Medical Ethics Manual

In 1999 the WMA reached agreement to publishits own medical ethics manual, and the Englishversion was accordingly completed in 2005.Individual national medical associations have beenpreparing translations of this English version intheir own national languages and distributingthem at a national level to people involved withhealthcare and legal affairs. The Japanese versionis the 13th produced. Copies were donated to the160,000 members in Japan and to all currentmedical school students. We understand that itis widely used as a textbook in ethics trainingprovided to clinic and hospital staff in Japan.

Indonesia Tsunami Recovery SupportProject

The JMA collected over 60 million yen or500,000 US$ in donations for Indonesia to assistwith recovery from the 2005 Indian Ocean earth-quake and allocated this sum through the AsianMedical Doctors Association or AMDA towardsthe establishment of a healthcare center in thesuburbs of Jogjakarta, Indonesia. Dr. Ishii, as

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CMAAO Secretary General, visited Indonesialast March in order to exchange memorandum

of understanding with the Indonesian HealthMinistry and the Indonesia Medical Association.



KOREAN MEDICAL ASSOCIATION

Dong Chun SHIN*1

Government’s Plan to Develop ‘MedicalIndustry’ and Revision of Medical Law

In 2005, the Korean government launched itsstrategic plan to develop the medical sectorinto a core future industry in Korea and hascontinued with follow-up measures to supportthe plan. The measures include diversificationof for-profit-business of hospitals, establishmentM&A procedures for hospitals, developmentof high-tech medical industry complexes andpromotion of private health insurance. Thesemeasures require institutional support in theform of an all-out revision of the Korean MedicalLaw, which was last revised 30 years ago. KMAagrees in principal to the government’s directionof active medical area promotion but at thesame time emphasizes that measures to preventnegative impact on underprivileged people shouldcome first. KMA also expresses concern that thegovernment’s plan is focused only on the hospital-level and doesn’t include strategies to strengthenfinancial structures of clinic-level medical services.Moreover, the plan cannot become fundamentalmeasures because it fails to address issues suchas improvement of regulations, review of under-estimated physician fee and increase of socialhealth insurance contributions. Regarding theproposed bill of the Medical Law revision, KMAclearly opposes it, as some provisions impose tooheavy legal obligations on physicians and someraise serious concern by expanding the scopeof practice by non-physician professionals. Forinstance, the bill stipulated that the obligation toexplain to patients is a ‘legal duty.’ The KMA’sposition is that this obligation is considered a‘moral obligation’ of physicians and should bedealt in the area of medical ethics. The bill alsodrafted a new stipulation banning on false keepingof medical records. False keeping of medical

records can be dealt with within the concept of“fraud” on the current criminal law and recklessestablishment of another penal stipulation mayresult in overuse of administrative disposition.KMA is planning to further keep a keen eyeon the proceedings of the bill and continue toexpress its stance to the government.

Criticism on Government’s Plan toEnforce Generic Prescribing

The government announced the plan to urgephysicians to issue generic prescribing as a wayof reducing health expenditure. One of thebiggest cost increases in Korean health care isprescription medications. On average, medica-tions accounted for over 30% of the total healthinsurance expenditure in 2005. KMA warned thegovernment that rushed enforcement of genericprescribing without proper infrastructure andstringent institutional requirement to ensure thesafety and quality of generics would harmpeople’s health. It was found in 2006 that somebioequivalence test results of generics werefabricated by the inspecting institutions. As aresult, their marketing approvals were cancelled.The Korea Food and Drug Administration(KFDA) is currently re-inspecting the bioequiva-lence of generics previously approved. However,notwithstanding this circumstance and KMA’sconcern, the government went ahead with a pilotprogram of generic prescription starting with theNational Medical Center (NMC) in September2007. Another concern of KMA is generic sub-stitution. Generic substitution may underminethe relationship between doctors and patients.Doctors face difficulties in treating patients,because changes in medication can influencecompliance with the course of treatment. Duringthe first 2 months of the pilot program, only 29 %of the patients subject to generic prescribing

*1 Executive Board Member, Korean Medical Association. Professor, Department of Preventive Medicine, College of Medicine, Yonsei University,Seoul, Korea ([email protected]).

Country Report


have been actually prescribed by generic names.KMA believes this low rate of compliance is aclear reflection of the concerns Korean physi-cians have about this new approach. KMA willcontinue to monitor the re-inspection processof KFDA to ensure the safety and quality ofgenerics and keep members and the publicinformed about the risk of hasty enforcement.

Controversies over a Bill on MedicalMalpractice Law

The National Assembly Sub-committee on Legis-lation passed a draft bill on Medical MalpracticeLaw in August 2007, imposing the burden provingno-fault on physicians. Efforts to legislate aMedical Malpractice Law have existed for 20years in Korea, but an agreement was neverreached due to its strong ramifications on thebehavior of physicians, the quality of medicalservices and thus on the entire health caresystem. The 2007 draft bill reflected opinionsof civil groups to a great extent in the followingcontroversial issues: 1) imposing the burden ofproving no-fault on physicians and 2) changingarbitration to a voluntary process. (Medicalmalpractice arbitration committee will be estab-lished, but whether to bring individual cases tothe committee depends on patients’ decisions.This means that patients can file a lawsuit withoutgoing through an arbitration process)

KMA expressed clear opposition to this draftbill. Imposing the burden of proving no-fault onphysicians will result in passive and defensivemedical treatment and avoidance of specialtieswhich involve a high possibility of medicalmalpractice among trainee for residency.

This bill failed to be submitted to the plenarysession of the National Assembly and wasautomatically annulled with the end of the termof the National Assembly this year. However,the lawmaker who proposed this bill is expectedto introduce the bill again next year. KMA willcontinue to make clear its stance and concerns onthe bill to lawmakers and the public. It plans todraft a separate bill which defines the burden ofproving no-faults based on general principles andmaintains an obligatory process of arbitration.

Preparation for 2008 WMA GeneralAssembly

The KMA will host the 2008 World MedicalAssociation (WMA) General Assembly in Seoulnext year (The Shilla Hotel) from October as apart of celebrating its centennial anniversary.With the assembly only one year away, KMAis pulling an all-out effort for the successfulhosting. Promotional materials (video, posterand leaflet) were presented at the 2007 WMACopenhagen General Assembly held last month,which attracted participants’ attention fromvarious countries. At the assembly, the proposedtheme for the scientific session “Health andHuman Rights” was approved. The preparationcommittee is now working on a detailed programand inviting renowned speakers for each session.A photo exhibition displaying the history ofKMA and medical societies is planned in parallelwith the Assembly. It will become an opportunityto look back on the traces of the medicaldevelopment in the last century and to set futurepriorities and strategies for the next century.



Shin DC


NEW ZEALAND MEDICAL ASSOCIATION

Peter FOLEY*1

the most urgent cases get priority in publichospitals. A major issue has been the removal ofsubsidies, in some regions, for patients of privatespecialists who require laboratory tests. TheNZMA believes this is inequitable and unfairboth to the patients and private specialists.

Medical registration in New Zealand is con-trolled by the Health Practitioners CompetenceAssurance Act 2003, which brought together allregistered health practitioners (such as doctors,nurses, dentists, midwives and physiotherapists)under the same registration, competency anddisciplinary procedures. The Act has the primaryaim of protecting the public. Of great concernto the NZMA is the fact that although the Actpermits regulations to be made which wouldallow for elected members to the Medical Councilof New Zealand (MCNZ), to date, the Ministerof Health has not done so. For the MCNZ towork effectively it must have the respect andconfidence of the profession, and that will nothappen while there are no directly electedmembers.

The medical workforce in New Zealandcontinues to be under extreme stress. The highfees and resulting debt levels incurred by medicalstudents in training lead to many newly-qualifiedNew Zealand doctors seeking higher-paid posi-tions overseas. Other problems include:• Increasing demand• Ageing workforce• Doctor dissatisfaction and morale leading to

retention issues• Insufficient medical student places (self-

sufficiency is needed)• Student debt• Long lead time to train doctors• Generational changes in work-life balance ex-

pectations• Inappropriate reliance on overseas trained

doctors (OTDs)Many of New Zealand’s practising doctors

*1 Chairman, New Zealand Medical Association, Wellington, New Zealand ([email protected]).

New Zealand’s health sector has been radicallytransformed over the past decade and a half.Successive governments with different perspec-tives and ideologies have made huge structuralchanges. The current Labour-led Government,headed by Prime Minister Helen Clark, is now 2years into its third 3-year term, and is in a phaseof consolidation rather than implementing newinitiatives. This Government now faces a strongchallenge from the main Opposition party, whichis leading in the polls.

Over the past 15 years democratically-electedregional hospital boards have been set up, abol-ished and replaced by commercial companies,and then re-introduced. New Zealand now has21 District Health Boards (DHBs) which areresponsible for providing government-fundedhealth care for the population in their region.DHBs focus on planning and delivering healthservices, running hospitals, overseeing primaryhealth care services and delivering some publichealth programmes.

Adequacy of funding at District Health Boardlevel is a continuing concern, with some runningcontinual deficits and/or cutting services to meetbudget constraints. The continuing inability ofmany DHBs to meet their commitments in respectof patient access to secondary and tertiaryservices continues to be of great concern. This isparticularly so in relation to first appointmentwith specialists, and the long waiting times formany elective procedures. The situation is furthercomplicated by the returning of many patientsfrom hospital waiting lists to the care of their GP.This lack of timely access to the care they needcauses great distress to many New Zealandersand their families.

Care in the private secondary health sector isavailable to those with health insurance or themeans to pay. More than 50% of elective surgerytakes place in the private sector, as fundingrestraints and restricted waiting lists mean only

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trained elsewhere in the world—currently 42%are from overseas countries. Doctor shortages insome regions and notably in rural areas continueto place extra demands on the profession.Specialities such as obstetrics, psychiatry andgeneral practice are particularly short. TheGovernment has established a Medical TrainingBoard to find solutions to workforce problems.The NZMA has long called for a comprehensivestrategic plan for the medical workforce whichwill address both the short and long term needfor medical practitioners in New Zealand.

Seven years ago the Government releasedits Primary Health Care Strategy, based oncapitated funding to general practices whichenrol their patients as members of a PrimaryHealth Organisation (PHO). PHOs receive publicfunding through District Health Boards. This wasthe biggest shake-up of the primary health sectorfor half a century.

The New Zealand Medical Associationsupported the broad proposals of the PrimaryHealth Care Strategy as having the potential toimprove the health of New Zealanders and theiraccess to primary health services. The Governmenthas progressively rolled out increased fundingto all age groups, which has enabled patient co-payments to be reduced. We have fought hard toretain the principle that GPs be able to set theirown fees, and charge a co-payment if necessary(as the government funding does not cover theentire cost of visiting a GP). The control of GPfees is shaping up to be a major election issue.

The NZMA continues to publish the NewZealand Medical Journal, which has been onlineonly since 2002. The NZMJ is the premierscientific medical journal for the profession inNew Zealand, and continues to publish wellregarded research on a wide variety of medicaltopics.

The NZMA provides the Code of Ethics forthe profession in New Zealand, and has beenreviewing the Code this year.

The NZMA works closely with the NZMedical Students’ Association, recognising thatstudents are the future of the profession. TheNZMA also has a Doctors-in-Training Council,which represents the interests of junior doctorsand medical student members.

Other NZMA initiatives include:• Around 50 submissions on a wide variety of

issues.• Running a successful Trainee Forum, with

participation from registrars from many of theMedical Colleges.

• The establishment of a Leadership Fund tosupport participation in leadership activities.

• Settling the largest multi-employer collectiveemployment agreement ever to be negotiated inNew Zealand (representing GPs as employersof practice nurses).

• Launching a new publication—the NZMJDigest.

• Producing a member resource on the CommerceAct, to enable medical practitioners to developan understanding of competition law andpractise safely within the confines of the law.It has been another busy and challenging

year for the NZMA. We place a high value onadvocacy for the health of the population andsupport for professional conditions. Continuingliaison with health sector policy makers, repre-sentation on consultative bodies, preparation ofsubmissions on health-related legislation andadvocacy about the introduction of new initiativescontinue to keep members actively engaged inimproving health care for all New Zealanders.We continue to work closely with other medicalorganisations both within the country and at aninternational level.

Foley P


SINGAPORE MEDICAL ASSOCIATION

Yik Voon LEE*1

*1 Honorary Treasurer, 48th Council, Singapore Medical Association, Singapore ([email protected]).

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Lee YV


TAIWAN MEDICAL ASSOCIATION

Ming-Been LEE*1

Striving for Medical ReconstructionFund

The increase of aging population, numbersqualify for serious injury and the introduction ofnew medical technologies have all contribute tothe annual 8–10% medical expenditure growthrate. The financial difficulty is extremely urgent.However, the Bureau of National Health Insur-ance has strengthened its control over healthcare facilities. The model it uses to control thepayment system contradicts with market mecha-nism and has led to a twisted and restrainedfuture for the health care development.

In 2005, the health care expenditure countedfor 6.16% of GDP in Taiwan. This is significantlylow compare to 8% in OECD countries and15.3% in the U.S.A. There is no doubt thatTaiwan is offering high quality health careservices with insufficient resource. Nevertheless,health care facilities face a discounted paymentsystem. This will danger the health care systemif it induces the health care facilities to collapseand the providers to break down.

In order to maintain the health service quality,improve peoples’ habit of accessing health careservices and health care system default, hold thepublic health system together, assure patients’right to access health care services, we havebeen striving for the government to budgetingthe “medical reconstruction fund” for 2 years.The main purpose is to add the budget to theunbalanced global budget payment system. Thepremier has finally agreed our appeal for 50billion dollars “medical reconstruction fund”budget in September of 2007.

Insurance Certification—IC card

Taiwan introduced National Health Insurance in1995. With the need of informationize, insurance

Installment of Taiwan MedicalAssociation’s New President andExecutives

Taiwan Medical Association held the presidentialelection at the first Representative Congress ofthe 8th term in May of 2007. Dr. Ming-Been Leewon majority votes from the representatives andcouncils and was installed as the new presidentof Taiwan Medical Association. In order toundertake our responsibilities as a member ofthe global society, Dr. Lee stresses his desireto strengthen the communication with othermedical associations and to share Taiwan’smedical system and experience through frequentinteractions.

Taiwan Medical Association WasAwarded the 2006 Excellent NationalProfessional Organization by Ministryof the Interior

In order to strengthen the function and structure,and enhance the development of professionalorganizations, Ministry of the Interior in Taiwanhosted an “Excellent National ProfessionalOrganization” performance screening. TaiwanMedical Association stood out from among 7,800organizations and was awarded by the Ministerof the Interior for the following reasons: Aggres-sively participate in cooperative plan hosted bythe Department of Health and WMA activities;undertake physician clinics global budget task;build global informational network; assist in phy-sicians’ national insurance enrollment, paymentand brochures’ edition; establish medical dedica-tion award to cite for physicians’ exceptionaldistribution to the health care industry; assistDOH in drawing up “Patient Safety Guidelines”as a reference to patients and families.

*1 President, Taiwan Medical Association, Taipei, ROC ([email protected]).

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certification evolved from paper into IC cardin 2004 and the first stage registration anduploading was implemented at the same time.In order to increase the accuracy of medicalinformation, reduce the consumption of medicalresources, monitor health care facilities thatpatients access and assist in the implementationof various prevention measures, the Bureau ofNational Health Insurance in Taiwan adopted adisciplinary and rewarding method to requesthealth care facilities to cooperate with secondstage registration and uploading in 2007. Themain contents include primary and secondarydiagnosis, medication, physician orders, fees...etc.However, Taiwan Medical Association continuesto negotiate with Department of Health and theBureau of National Health Insurance not toforce the implementation by using disciplinaryway due to the suspection from different facetssuch as: facilities’ settlement, ability to handleinformation and the doubt of service quality,ethics, privacy, legal and practical operation. Weare still continuing our talks with other partiesin order to reduce the impact this has caused tohealth care facilities.

Taiwan Medical Association Signed aMemorandum of Understanding withthe Argentina Medical Association

Taiwan Medical Association signed a bilateral

Avian Flu cooperative memorandum of Under-standing with Dr. Jorge Carlos Janez, Presidentof the Argentina Medical Association, in Aprilof 2007 based on the standpoint of “diseaseswithout borders.” The main purpose is to bringNGO’s participation in international epidemicprevention into play through both organizations’interaction and cooperation with the hopeto assist people and government from bothcountries to completely prevent avian flu fromhappening again.

Taiwan Medical Association’sRepresentative Made a Keynote Speechin 2007 World Medical Assembly

Dr. Heng-Shuen Chen from the Taiwan MedicalAssociation was invited to be the speaker of2007 World Medical Assembly Scientific Sessionon the topic “e-Health Solutions for Systems inDevelopment.”

Dr. Chen gave a detail introduction onTaiwan’s medical technology, such as IC card,telemedicine, the development and research intelemedicine in recent years, and how to combineother information systems to promote healthcare quality...etc.



Lee MB

3264 JMAJ, March /April 2008 — Vol. 51, No. 2

*1 President, Hong Kong Medical Association, Hong Kong ([email protected]).

SymposiumArts and Science of Healthy Longevity

Towards Healthy Longevity

CHOI Kin*1

[Hong Kong]

33 65JMAJ, March /April 2008 — Vol. 51, No. 2



Choi K


Towards Healthy Longevity in Indonesia

Czeresna H. SOEJONO,*1 Purwita W. LAKSMI

*1 Indonesian Medical Association, Jakarta, Indonesia ([email protected]).

The population is aging. By the year 2050, 12countries are projected to have more than 10%of oldest-old population. They include not onlycountries in Europe, but also in Asia Pacificregion. Furthermore, five countries will have 10million or more people over 80 years old, includ-ing China, India, the United States, Japan andIndonesia [United Nations Information Centre].

In 2005, there are 16,440,500 people age 60years and older in Indonesia and it is estimatedthat the number will increase to 19,079,800 peo-ple or 8.15% of total Indonesian population in2010 (BPS, 2005).

Many diseases and disabilities will then ensue,ranging from infection, hypertension, diabetesmellitus, instability, immobility, osteoporosis, andfracture to depression, dementia, overactivebladder and insomnia. The health problems arethus inevitable. Elderly people are bound toplace an enormous personal and socioeconomicburden on their families and society, unless promptaction is undertaken to quickly develop betterprevention and treatment programs for many ofthe physical and mental ailments associated withold age. Compared with younger patients, olderpatients have longer and more frequent hospital-izations and their illness severity is greater. Costof hospitalization are higher in elderly patientscompared to younger adults.

Geriatric patients are elderly patients withcertain characteristics: coincidence of multiplehealth problems in one person, tendency forpolypharmacy, decreased or limited physiologicreserves in multiple organ system, decreasedfunctional status, atypical presentation of illness,and usually have malnutrition condition andpsychosocial problems. Thus the approach to theelderly person requires a perspective differentfrom that needed for medical evaluation ofyounger persons, which called comprehensivegeriatric assessment (CGA).

Traditional medical evaluation typically focuseson the medical care of disease-specific and life-

threatening illnesses, while less attention is given tofunctional outcomes such as physical and cognitivefunctioning which may be critical determinantsof the quality of life, physical independence, costof care, and prognosis among elderly patients.CGA extends beyond the traditional medicalevaluation to include assessment of cognitive,affective, functional, social, economic, environ-mental, and spiritual status, as well as a discussionof patient preferences regarding advance direc-tives. In addition, to improve clinical outcomesof hospitalization, CGA are conducted by inter-disciplinary team to include doctors from kindsof specialties, nutritionists, pharmacists, geron-tological nurses, therapists (physical, occupation,and speech), and social workers.

The health care system of geriatric care consistof hospital-based care which include acute careand sub acute care and community-based carewhich include nursing home care and home careservices. Acute care setting is comprehensiveinpatient care designed for someone who has anacute illness, injury, or exacerbation of a diseaseprocess, while sub acute care setting is designedfor someone who no longer required acute careservices and did not need (or want) long-termcare placement, but who was not yet sufficientlyrecovered from his/her acute illness to returnhome and still requiring medical managementand/or functional rehabilitation within the skillednursing facility. The interdisciplinary process ofdischarge planning in acute care unit serves toidentify patients who will need nursing homeplacement or home care services, to estimate thepatient’s hospital length of stay, to educate thepatient and family about the patient’s diagnosis,prognosis, and choices for discharge location,and to review medications, home safety, and thepromotion of self-care.

Bearing in mind the imminent health problemsin the elderly, it is important to make it possibleto deliver the right care, in the right place, at theright time, by the right practitioner and to organize

[Indonesia]



good insurance health care financing program.The long and winding road to the establish-

ment of geriatric care in Indonesia has begun since1966 when one of the pioneers of our geriatriccare, R. Boedhi Darmojo, MD, studied gerontol-ogy and geriatric medicine abroad. This wasfollowed by the first national symposium ongeriatric medicine 10 years later. In 1994, threehospitals (Ciptomangunkusumo Hospital, Jakarta;Kariadi Hospital, Semarang, Central Java; SardjitoHospital, Yogyakarta) were appointed by Minis-try of Health to be the pioneer hospitals whichserve integrated geriatric care. But it was notuntil 1996 when geriatric medicine became partof the curriculum and being taught to internalmedicine residents/undergraduate students andthe Indonesia Medical Gerontology Associa-tion being established under bow the IndonesiaMedical Association.

Now, the Indonesia Medical GerontologyAssociation has 15 branches all over Indonesia(Medan, Padang, Pekanbaru, Palembang, Jakarta,

Bandung, Semarang, Solo, Yogyakarta, Malang,Surabaya, Denpasar, Makasar, Manado, BandaAceh) with 7 branches as center of educationwhich teach geriatric medicine to undergraduatestudents and 4 branches which also teach geriatricmedicine to internists who want to be internist-geriatricians. The contribution to the community-based geriatric care is through training ofPUSAKA personals.

Indonesia still lack of human resources concern-ing that there are only 15 internist-geriatriciansuntil now who have to serve more than 10 millionelderly people. We are also lack of facilities ofgeriatric care, research and training in geriatricmedicine for internists, GPs, nurses, and layman.Lastly, government support and health careinsurance support system are all still neededto make better health management, as wellas international collaboration to exchange infor-mation and experiences vital to the advancementof health and research in geriatric medicine inIndonesia.

Soejono CH, Laksmi PW


*1 Executive Board Member, Japan Medical Association, Tokyo, Japan ([email protected]).

Introduction

With regard to the rights of Japanese citizens tolife and health, Article 25 of the Japanese Con-stitution, promulgated in 1947, stipulates that:“(1) All people shall have the right to maintainthe minimum standards of wholesome and cul-tured living” and “(2) In all spheres of life, theState shall use its endeavors for the promotionand extension of social welfare and security, andof public health.”

Based on Article 25, various social welfarerelated laws such as the Living Protection Law,Child Welfare Law, and Physically HandicappedPersons Welfare Law, as well as social insurancerelated laws such as the National Health Insur-ance Law, National Pension Law, and Unemploy-ment Insurance Law, were established one afterthe other in the past 60 years. These laws havecontributed tremendously to the stabilization ofpeople’s livelihoods, preservation of life, andmaintenance and enhancement of health.

Since that time, the living conditions in Japanhave improved with high economic growth andchanges in industrial structure; moreover, withthe nationwide spread of public health endeavorssuch as vaccinations and medical examinations,Japan came to have the world’s highest longevity.In 1947, the average life expectancy for men inJapan was 50.06 and for women 53.96; in 2006,the average life expectancy for men was 79.00and for women was 85.81—and increase ofaround 30 years for both men and women overa half century.

According to World Health Organization(WHO) data,1 Japan is also ranked Number 1 inthe world for healthy life expectancy.

People living into their eighties and beyondhas become a reality, and so the important chal-lenge for the future is to not simply extend life

—in other words, a quantitative response—but todevise and implement measures for improvingQuality of Life (QOL)—in other words, a quali-tative response.

Attitude towards “Healthcare”:from consumption to investment

National healthcare expenditure in Japan hasgrown from 513 billion yen or 4 billion US$ in1961, when the universal healthcare system wasestablished, to some 33.1289 trillion yen or 2,760billion US$ in 2005. Behind this increase inhealthcare expenditure are a range of factorsincluding population growth, aging of society,and advancement of healthcare; however, withthe long-term stagnation of the Japanese economyin the wake of the collapse of the so-called eco-nomic bubble, the Japanese Government in recentyears has continued to strongly move to restricthealthcare expenditure.

Approximately one-quarter of funding fornational healthcare expenditure is providedthrough public funds, and this has led to theconstriction of benefits ands restriction of health-care expenditure.

However, according to Organization for Eco-nomic Cooperation and Development (OECD)data,2 in 2004 Japan’s total healthcare expendi-ture was 8% of percentage of GDP, which placesJapan nine points below the OECD membercountry average of 8.9% with a ranking of 22out of 30 countries. In other words, low expendi-ture in healthcare compared with the country’seconomic strength supports the improvement ofcitizens’ health.

With the growth in public expenditure to coverincreasing healthcare expenditure, healthcare isnow frequently discussed in terms of “consump-tion.” However, as Japan becomes an increas-ingly aging society with fewer children, it is

[Japan]


Health Policy toward the LongevitySociety in Japan

Takashi HANYUDA*1


imperative that both the government and thegeneral public develop an awareness of health-care as a useful “investment” for advancingthe health of citizens, thereby maintaining andimproving the nation’s vitality.

From Secondary to Primary PreventativeMeasures

With the improvement in living conditions, rais-ing of living standards, and changes in dietaryhabits over the past decades, disease compositionin Japan has also changed tremendously. Froma time when tuberculosis and respiratory tractinfections were the most common diseases, todaycancer, cerebral stroke, and heart diseases arethe cause of death in some 60% of cases. Thesediseases are also known as “lifestyle related dis-eases,” with clinical and epidemiological researchclearly showing the influence of individualpeople’s lifestyles on their health.

Measures that take this situation into consid-eration recognize the importance of focusing onprimary prevention through improving people’slifestyles rather than on secondary preventionthat centers on conventional health checkupsaimed at early detection and diagnosis of diseases.

The WHO Ottawa Charter for Health Promo-tion states that health is an important resourcefor both individuals and society as a whole, andproclaims the necessity of improving and pro-moting health.

In Japan, too, the Health Promotion Law waspromulgated in 2002 with the aim of establishingan infrastructure for actively promoting healthimprovement and disease prevention throughnational consensus.

Moreover, a new law to ensure healthcare forthe elderly will come into force in April of 2008,implementing new measures for preventing life-style related diseases by, for example, requiring“health check-ups and guidance for specific dis-eases” to be provided for all people in Japan withhealthcare insurance as a means of preventingand treating metabolic syndrome in particular.

In this way, Japan’s health policies are shiftingfrom secondary prevention-centered measuresto primary prevention focusing on preventingdiseases from developing, and there is further-more a gradual shift towards measures and policiesthat focus on “health promotion” that activelyraises health levels.

Establishment of the LifelongHealthcare Service Program

Lifelong healthcare services in Japan have beensystemized centered on medical check-ups, withMaternal and Child Healthcare for childrenyounger than school age, School Healthcare forchildren of school age, Occupational Healthcarefor people during their working years, andElderly Healthcare for seniors.

However, different ministries, departments,and agencies administer each of these healthcareservices and they are implemented indepen-dently; consequently, health information for anyindividual person is not managed in an integratedmanner. These systems have been organized aslifelong healthcare services, but they cannot besaid to be operating appropriately overall if nosystem for managing health information over alifetime is maintained.

The quality of individual citizens’ health isexpected to improve as a result of the implemen-tation of healthcare services such as healthcheck-ups, education, and guidance tailored topeople’s lifestyles as well as the detection ofchanges in health through integrated manage-ment of health data. To this end, it is vital thatobjective evaluation indicators be developed forviewing the accumulation of “Capital of health”through these services.

The cooperation on coordination of alliedhealth personnel is imperative for the develop-ment of comprehensive and effective health ser-vices. It is hoped that local medical associations,which have developed various community-basedhealth services over their long histories, willmake systematically contributions in response tothese needs.

Concluding Remarks

In order to create a system that maintains andimproves the “Capital of health” for citizens overtheir lifetimes, it is vital that not only are thelaws and ordinances that form the foundationfor individual healthcare services revised in acomprehensive manner, but that a framework forcomprehensively providing health insurance andhealthcare be secured. To achieve this, financialsupport is imperative and many issues must beresolved.

Hanyuda T


In particular, as mentioned above, the JapaneseGovernment in recent years has been eagerlyworking to contain social security expenditure,especially healthcare expenditure. Consequently,insufficiencies have arisen in the absolute num-bers of doctors and other health professionals,whose responsibility it is to protect the health ofthe public, and reviews of these and other “bur-dens” that have resulted from reforms that havegone too far are now being discussed.

Considering the situation in Japan, where theaging of society is progressing at an unparalleledspeed, environmental improvement measuressuch as the enhancement of healthcare servicesand spread of new medical technologies basedon a stable financial foundation for enhancinghealth insurance and healthcare are imperative.

In other words, by enhancing the health capi-tal of citizens through measures such as these, itbecomes more possible to extend the age up untilpeople can work and to encourage employment.

This in turn leads to increased GDP and taxrevenue and contributes to the establishment ofa financial foundation.

Transforming the inherently unstable agingsociety with fewer children into a stable society bycreating “positive” cycles such as this is regardedas the response that Japan is demanding.

As mentioned at the beginning, Article 25 ofthe Japanese Constitution stipulates that thenation has a mission to endeavor to improve andadvance social welfare, social security and publichealth.

Considering the improvements in living stan-dards in Japan that accompanied the remarkableeconomic development and changes in the socialenvironment, such as the strengthening of peo-ple’s awareness of their rights, it is imperativethat the national government take a stance ofpromoting social welfare, social security, andpublic health at a consistently higher level.


References

1. WHO, The World Health Report 2004. 2. OECD Health Data 2007.


Hanyuda T

79JMAJ, March /April 2008 — Vol. 51, No. 2

Long-term Care Act in Korea

Dong Chun SHIN*1

[Korea]


*1 Executive Board Member, Korean Medical Association. Professor, Department of Preventive Medicine, Yonsel University, Seoul, Korea([email protected]).


Long-term Care Act in Korea

Dong Chun SHIN*1

[Korea]


*1 Executive Board Member, Korean Medical Association. Professor, Department of Preventive Medicine, Yonsel University, Seoul, Korea([email protected]).


Shin DC




Siang Chin TEOH*1

[Malaysia]

*1 Immediate Past President of Malaysian Medical Association. Chairman of Medical Association of South East Asian Nations (MASEAN), KualaLumpur, Malaysia ([email protected]).


MALAYSIAN MEDICAL ASSOCIATION


Teoh SC


MALAYSIAN MEDICAL ASSOCIATION


Teoh SC



CHIN Jing Jih*1

*1 Council Member, 48th Council, Singapore Medical Association, Singapore ([email protected]).

[Singapore]



Chin JJ




Liang-Kung CHEN*1

[Taiwan]

*1 Taiwan Medical Association, Taipei, ROC ([email protected]).


Chen LK

99JMAJ, March /April 2008 — Vol. 51, No. 2

Longevity of Thai Physicians

Pornchai SITHISARANKUL,*1 Somkiat WATTANASIRICHAIGOON*2

*1 Professor, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand([email protected]).*2 Professor, Dean of the Faculty of Medicine, University of Srinakarintaviroj, Bangkok, Thailand.

[Thailand]



Longevity of Thai Physicians

Pornchai SITHISARANKUL,*1 Somkiat WATTANASIRICHAIGOON*2

*1 Professor, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand([email protected]).*2 Professor, Dean of the Faculty of Medicine, University of Srinakarintaviroj, Bangkok, Thailand.

[Thailand]



Sithisarankul P, Wattanasirichaigoon S


MEDICAL ASSOCIATION OF THAILAND


Sithisarankul P, Wattanasirichaigoon S

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